15D2229131 CLIA NUMBER - NURSE PRACTITIONER SERVICES OF MICHIANA

Laboratory Demographics

CLIA Number: 15D2229131

Facility Name: NURSE PRACTITIONER SERVICES OF MICHIANA

Facility Address:
55756 REEVES DR
OSCEOLA, IN
ZIP 46561
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Facility Phone Number: 574 622-1522

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1225605207

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2229131
LAB Type	Practitioner Other
Facility Name	NURSE PRACTITIONER SERVICES OF MICHIANA
Street	55756 REEVES DR
City	OSCEOLA
State	IN
ZIP	46561
Phone	574 622-1522
CertificateType	4
CertificateEffectiveDate	7/7/2023
CertificateExpirationDate	7/6/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024