35D2176936 CLIA NUMBER - CANOPY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 35D2176936
  • Facility Name: CANOPY MEDICAL CLINIC
  • Facility Address: 1411 32ND ST S, STE 1
    FARGO, ND
    ZIP 58103
  • Facility Phone: 701 264-5200
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: HEIDI L. SELZLER-ECHOLA
  • NPI Number: 1386280261
  • Taxonomy: 363LW0102X - Nurse Practitioner

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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
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/30/2023
Certificate Expiration Date 12/29/2025
Facility Type Practitioner Other
Lab Director HEIDI L. SELZLER-ECHOLA

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