23D2320620 CLIA NUMBER - LENAE E VANWAGNEN MD

Laboratory Demographics

  • CLIA Code: 23D2320620
  • Facility Name: LENAE E VANWAGNEN MD
  • Facility Address: 1310 GREENWOOD AVENUE
    JACKSON, MI
    ZIP 49203
  • Facility Phone: 517 962-0123
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LENAE E. VANWAGNEN
  • NPI Number: 1689626400
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 23D2320620
LAB Type Physician Office
Facility Name LENAE E VANWAGNEN MD
Street 1310 GREENWOOD AVENUE
City JACKSON
State MI
ZIP 49203
Phone 517 962-0123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Physician Office
Lab Director LENAE E. VANWAGNEN

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