35D1001562 CLIA NUMBER - ESSENTIA HEALTH - 45TH ST CLINIC

Laboratory Demographics

  • CLIA Code: 35D1001562
  • Facility Name: ESSENTIA HEALTH - 45TH ST CLINIC
  • Facility Address: 4476 31ST AVE S
    FARGO, ND
    ZIP 58104
  • Facility Phone: 701 364-3181
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: AMANDA J. BUETTNER
  • NPI Number: 1891453411
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D1001562
LAB Type Community Clinic
Facility Name ESSENTIA HEALTH - 45TH ST CLINIC
Street 4476 31ST AVE S
City FARGO
State ND
ZIP 58104
Phone 701 364-3181
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2025
Certificate Expiration Date 8/7/2027
Facility Type Community Clinic
Lab Director AMANDA J. BUETTNER

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