25D2137226 CLIA NUMBER - NURSE PRACTITIONER HOUSE CALLS

Laboratory Demographics

CLIA Number: 25D2137226

Facility Name: NURSE PRACTITIONER HOUSE CALLS

Facility Address:
109 E DONALD ST STE 1
QUITMAN, MS
ZIP 39355
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Facility Phone Number: 601 513-8508

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1982115945

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	25D2137226
LAB Type	Practitioner Other
Facility Name	NURSE PRACTITIONER HOUSE CALLS
Street	109 E DONALD ST STE 1
City	QUITMAN
State	MS
ZIP	39355
Phone	601 513-8508
CertificateType	4
CertificateEffectiveDate	12/1/2022
CertificateExpirationDate	11/30/2024
FacilityType	Waiver

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