24D2243099 CLIA NUMBER - NORTH COUNTRY PSYCHIATRY

Laboratory Demographics

CLIA Number: 24D2243099

Facility Name: NORTH COUNTRY PSYCHIATRY

Facility Address:
1300 BOLLENBACHER DR, SUITE B
NORTHFIELD, MN
ZIP 55057
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Facility Phone Number: 507 301-2627

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760078760

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	24D2243099
LAB Type	Physician Office
Facility Name	NORTH COUNTRY PSYCHIATRY
Street	1300 BOLLENBACHER DR, SUITE B
City	NORTHFIELD
State	MN
ZIP	55057
Phone	507 301-2627
CertificateType	4
CertificateEffectiveDate	11/16/2023
CertificateExpirationDate	11/15/2025
FacilityType	Waiver

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