25D1069202 CLIA NUMBER - EVA GORDON ELEMENTARY SCHOOL SCHOOL NURSE OFFICE

Laboratory Demographics

CLIA Number: 25D1069202

Facility Name: EVA GORDON ELEMENTARY SCHOOL SCHOOL NURSE OFFICE

Facility Address:
1175 NORTH CLARK STREET
MAGNOLIA, MS
ZIP 39652
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Facility Phone Number: 601 783-0434

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1427260611

Taxonomy: 163WS0200X - Registered Nurse

CLIA Record

Field Name	Field Value
CLIA Number	25D1069202
LAB Type	School/Student Health Service
Facility Name	EVA GORDON ELEMENTARY SCHOOL SCHOOL NURSE OFFICE
Street	1175 NORTH CLARK STREET
City	MAGNOLIA
State	MS
ZIP	39652
Phone	601 783-0434
CertificateType	4
CertificateEffectiveDate	8/16/2022
CertificateExpirationDate	8/15/2024
FacilityType	Waiver

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