14D2019062 CLIA NUMBER - NONA FULK MD SC

Laboratory Demographics

  • CLIA Code: 14D2019062
  • Facility Name: NONA FULK MD SC
  • Facility Address: 1300 FRANKLIN AVE #330
    NORMAL, IL
    ZIP 61761
  • Facility Phone: (309) 808-0940
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: NONA FULK MD
  • NPI Number: 1063745883
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 14D2019062
LAB Type Physician Office
Facility Name NONA FULK MD SC
Street 1300 FRANKLIN AVE #330
City NORMAL
State IL
ZIP 61761
Phone 3098080940
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 1/21/2025
Certificate Expiration Date 1/20/2027
Facility Type Physician Office
Lab Director NONA FULK MD

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This page was last updated on: 5/18/2026