36D2165476 CLIA NUMBER - CYNTHIA DOUGHTY, CNP FAMILY PRACTICE LLC DBA MILESTONE PROGRESSIVE CARE

Laboratory Demographics

CLIA Number: 36D2165476

Facility Name: CYNTHIA DOUGHTY, CNP FAMILY PRACTICE LLC DBA MILESTONE PROGRESSIVE CARE

Facility Address:
2691 SAWBURY BLVD
COLUMBUS, OH
ZIP 43235
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Facility Phone Number: 614 710-1496

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1215332192

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	36D2165476
LAB Type	Practitioner Other
Facility Name	CYNTHIA DOUGHTY, CNP FAMILY PRACTICE LLC DBA MILESTONE PROGRESSIVE CARE
Street	2691 SAWBURY BLVD
City	COLUMBUS
State	OH
ZIP	43235
Phone	614 710-1496
CertificateType	4
CertificateEffectiveDate	4/29/2023
CertificateExpirationDate	4/28/2025
FacilityType	Waiver

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