35D2047109 CLIA NUMBER - ESSENTIA HEALTH - NORTH FARGO OCC MEDICINE

Laboratory Demographics

  • CLIA Code: 35D2047109
  • Facility Name: ESSENTIA HEALTH - NORTH FARGO OCC MEDICINE
  • Facility Address: 1100 19TH AVE N SUITE L&M
    FARGO, ND
    ZIP 58102
  • Facility Phone: 701 364-3335
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA J. BUETTNER
  • NPI Number: 1568918902
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D2047109
LAB Type Physician Office
Facility Name ESSENTIA HEALTH - NORTH FARGO OCC MEDICINE
Street 1100 19TH AVE N SUITE L&M
City FARGO
State ND
ZIP 58102
Phone 701 364-3335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2024
Certificate Expiration Date 9/17/2026
Facility Type Physician Office
Lab Director AMANDA J. BUETTNER

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