16D2016131 CLIA NUMBER - WHOLE WOMAN HEALTH

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Laboratory Demographics

CLIA Number: 16D2016131

Facility Name: WHOLE WOMAN HEALTH

Facility Address:
4507 FOREST AVENUE
DES MOINES, IA
ZIP 50311
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Facility Phone Number: 515 243-6309

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1346548419

Taxonomy: 363LX0001X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	16D2016131
LAB Type	Practitioner Other
Facility Name	WHOLE WOMAN HEALTH
Street	4507 FOREST AVENUE
City	DES MOINES
State	IA
ZIP	50311
Phone	515 243-6309
CertificateType	4
CertificateEffectiveDate	11/12/2022
CertificateExpirationDate	11/11/2024
FacilityType	Waiver

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