22D2301269 CLIA NUMBER - BLUE HERON PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 22D2301269
  • Facility Name: BLUE HERON PRIMARY CARE
  • Facility Address: 28 RIVERSIDE DR STE 150
    PEMBROKE, MA
    ZIP 02359
  • Facility Phone: 508 810-1980
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MICHELE A. MASSE
  • NPI Number: 1356114300
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 22D2301269
LAB Type Practitioner Other
Facility Name BLUE HERON PRIMARY CARE
Street 28 RIVERSIDE DR STE 150
City PEMBROKE
State MA
ZIP 02359
Phone 508 810-1980
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Practitioner Other
Lab Director MICHELE A. MASSE

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