14D0992335 CLIA NUMBER - PROACTIVE WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 14D0992335
  • Facility Name: PROACTIVE WELLNESS CENTER
  • Facility Address: 14044 PETRONELLA DRIVE, SUITE 3
    LIBERTYVILLE, IL
    ZIP 60048
  • Facility Phone: 847 549-6044
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: MARY STOWELL
  • NPI Number: 1174664882
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 14D0992335
LAB Type Practitioner Other
Facility Name PROACTIVE WELLNESS CENTER
Street 14044 PETRONELLA DRIVE, SUITE 3
City LIBERTYVILLE
State IL
ZIP 60048
Phone 847 549-6044
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/15/2023
Certificate Expiration Date 10/14/2025
Facility Type Practitioner Other
Lab Director MARY STOWELL

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This page was last updated on: 9/29/2025