15D2234233 CLIA NUMBER - DRAGONFLY PRIMARY CARE

Laboratory Demographics

CLIA Number: 15D2234233

Facility Name: DRAGONFLY PRIMARY CARE

Facility Address:
6835 E SOUTHPORT RD SUITE D
INDIANAPOLIS, IN
ZIP 46237
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Facility Phone Number: 317 759-1843

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1033782156

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	15D2234233
LAB Type	Practitioner Other
Facility Name	DRAGONFLY PRIMARY CARE
Street	6835 E SOUTHPORT RD SUITE D
City	INDIANAPOLIS
State	IN
ZIP	46237
Phone	317 759-1843
CertificateType	4
CertificateEffectiveDate	8/30/2023
CertificateExpirationDate	8/29/2025
FacilityType	Waiver

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