34D2283511 CLIA NUMBER - LIFE MOBILE WELLNESS

Laboratory Demographics

CLIA Number: 34D2283511

Facility Name: LIFE MOBILE WELLNESS

Facility Address:
219 WEST MAIN AVE UNIT 8
GASTONIA, NC
ZIP 28052
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Facility Phone Number: 980 246-1342

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578240008

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	34D2283511
LAB Type	Physician Office
Facility Name	LIFE MOBILE WELLNESS
Street	219 WEST MAIN AVE UNIT 8
City	GASTONIA
State	NC
ZIP	28052
Phone	980 246-1342
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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