28D2160170 CLIA NUMBER - SKIN ENVY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 28D2160170
  • Facility Name: SKIN ENVY DERMATOLOGY
  • Facility Address: 3140 E ELK LANE, STE 600
    FREMONT, NE
    ZIP 68025
  • Facility Phone: 402 963-6198
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DEBRA L. BAKER
  • NPI Number: 1154895209
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 28D2160170
LAB Type Practitioner Other
Facility Name SKIN ENVY DERMATOLOGY
Street 3140 E ELK LANE, STE 600
City FREMONT
State NE
ZIP 68025
Phone 402 963-6198
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2025
Certificate Expiration Date 1/6/2027
Facility Type Practitioner Other
Lab Director DEBRA L. BAKER

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