15D2187964 CLIA NUMBER - UPSTREAM HEALTH AND WELLNESS

Laboratory Demographics

  • CLIA Code: 15D2187964
  • Facility Name: UPSTREAM HEALTH AND WELLNESS
  • Facility Address: 3207 WILLOWCREEK ROAD SUITE A
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: 219 763-3636
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ROBIN M. ANDERSON
  • NPI Number: 1174082523
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D2187964
LAB Type Practitioner Other
Facility Name UPSTREAM HEALTH AND WELLNESS
Street 3207 WILLOWCREEK ROAD SUITE A
City PORTAGE
State IN
ZIP 46368
Phone 219 763-3636
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Practitioner Other
Lab Director ROBIN M. ANDERSON

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