19D2149062 CLIA NUMBER - ESSENTIAL FAMILY MEDICINE, LLC

Laboratory Demographics

CLIA Number: 19D2149062

Facility Name: ESSENTIAL FAMILY MEDICINE, LLC

Facility Address:
1902 STUBBS AVENUE
MONROE, LA
ZIP 71201
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Facility Phone Number: 318 367-2236

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1588153738

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	19D2149062
LAB Type	Practitioner Other
Facility Name	ESSENTIAL FAMILY MEDICINE, LLC
Street	1902 STUBBS AVENUE
City	MONROE
State	LA
ZIP	71201
Phone	318 367-2236
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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