30D2321644 CLIA NUMBER - REVOLUTION LONGEVITY AND WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 30D2321644
  • Facility Name: REVOLUTION LONGEVITY AND WELLNESS LLC
  • Facility Address: 91 PORTSMOUTH AVE, STE E
    STRATHAM, NH
    ZIP 03885
  • Facility Phone: 603 793-5969
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANN FISHER
  • NPI Number: 1932096674
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 30D2321644
LAB Type Practitioner Other
Facility Name REVOLUTION LONGEVITY AND WELLNESS LLC
Street 91 PORTSMOUTH AVE, STE E
City STRATHAM
State NH
ZIP 03885
Phone 603 793-5969
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Practitioner Other
Lab Director ANN FISHER

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