15D2312298 CLIA NUMBER - EMPOWER WELLNESS CENTER, LLC

Laboratory Demographics

  • CLIA Code: 15D2312298
  • Facility Name: EMPOWER WELLNESS CENTER, LLC
  • Facility Address: 12722 TONKEL ROAD SUITE D
    FORT WAYNE, IN
    ZIP 46845
  • Facility Phone: (260) 284-4880
  • Facility Type: Health Main. Organization
  • Facility Type: Waiver
  • Lab Director: STACIE LYNN HOUSHOLDER
  • NPI Number: 1477390128
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D2312298
LAB Type Health Main. Organization
Facility Name EMPOWER WELLNESS CENTER, LLC
Street 12722 TONKEL ROAD SUITE D
City FORT WAYNE
State IN
ZIP 46845
Phone 2602844880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/8/2024
Certificate Expiration Date 10/7/2026
Facility Type Health Main. Organization
Lab Director STACIE LYNN HOUSHOLDER

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