20D2296107 CLIA NUMBER - BREANNA LIBBY FNP-BC DBA MOOSABEC MEDICAL

Laboratory Demographics

  • CLIA Code: 20D2296107
  • Facility Name: BREANNA LIBBY FNP-BC DBA MOOSABEC MEDICAL
  • Facility Address: 298 MAIN ST
    JONESPORT, ME
    ZIP 04649
  • Facility Phone: 207 598-9648
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BREANNA L. LIBBY
  • NPI Number: 1104344134
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 20D2296107
LAB Type Practitioner Other
Facility Name BREANNA LIBBY FNP-BC DBA MOOSABEC MEDICAL
Street 298 MAIN ST
City JONESPORT
State ME
ZIP 04649
Phone 207 598-9648
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Practitioner Other
Lab Director BREANNA L. LIBBY

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