29D2235167 CLIA NUMBER - REVOLUTION HEALTH

Laboratory Demographics

  • CLIA Code: 29D2235167
  • Facility Name: REVOLUTION HEALTH
  • Facility Address: 2500 WIGWAM PKWY STE 111
    HENDERSON, NV
    ZIP 89074
  • Facility Phone: 904 703-1202
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KATIE BASS
  • NPI Number: 1356015218
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 29D2235167
LAB Type Practitioner Other
Facility Name REVOLUTION HEALTH
Street 2500 WIGWAM PKWY STE 111
City HENDERSON
State NV
ZIP 89074
Phone 904 703-1202
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Practitioner Other
Lab Director KATIE BASS

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