35D2176936 CLIA NUMBER - CANOPY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 35D2176936

Facility Name: CANOPY MEDICAL CLINIC

Facility Address:
1411 32ND ST S, STE 1
FARGO, ND
ZIP 58103
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Facility Phone Number: 701 264-5200

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1386280261

Taxonomy: 363LW0102X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	35D2176936
LAB Type	Practitioner Other
Facility Name	CANOPY MEDICAL CLINIC
Street	1411 32ND ST S, STE 1
City	FARGO
State	ND
ZIP	58103
Phone	701 264-5200
CertificateType	3
CertificateEffectiveDate	12/30/2023
CertificateExpirationDate	12/29/2025
FacilityType	PPMP

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