23D2132976 CLIA NUMBER - AMANDA K NIXON PA-C, P C

Laboratory Demographics

CLIA Number: 23D2132976

Facility Name: AMANDA K NIXON PA-C, P C

Facility Address:
202 S HOWARD ST P O BOX 74
TUSTIN, MI
ZIP 49688
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Facility Phone Number: 231 465-4165

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912250861

Taxonomy: 363AM0700X - Physician Assistant

CLIA Record

Field Name	Field Value
CLIA Number	23D2132976
LAB Type	Physician Office
Facility Name	AMANDA K NIXON PA-C, P C
Street	202 S HOWARD ST P O BOX 74
City	TUSTIN
State	MI
ZIP	49688
Phone	231 465-4165
CertificateType	4
CertificateEffectiveDate	7/3/2023
CertificateExpirationDate	7/2/2025
FacilityType	Waiver

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