18D2312448 CLIA NUMBER - JOMON WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 18D2312448
  • Facility Name: JOMON WELLNESS LLC
  • Facility Address: 132 FRONTIER BLVD SUITE 103
    STANFORD, KY
    ZIP 40484
  • Facility Phone: 859 287-2949
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. TRACY M. BOLLER
  • NPI Number: 1922853860
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 18D2312448
LAB Type Physician Office
Facility Name JOMON WELLNESS LLC
Street 132 FRONTIER BLVD SUITE 103
City STANFORD
State KY
ZIP 40484
Phone 859 287-2949
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Physician Office
Lab Director MS. TRACY M. BOLLER

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