37D2200865 CLIA NUMBER - WILLOW HEALTH & WELLNESS CHANDRA AKE, APRN-CNP, LLC

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Laboratory Demographics

CLIA Number: 37D2200865

Facility Name: WILLOW HEALTH & WELLNESS CHANDRA AKE, APRN-CNP, LLC

Facility Address:
916 N ELM ST
SEILING, OK
ZIP 73663
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Facility Phone Number: 580 922-1385

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346836137

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D2200865
LAB Type	Physician Office
Facility Name	WILLOW HEALTH & WELLNESS CHANDRA AKE, APRN-CNP, LLC
Street	916 N ELM ST
City	SEILING
State	OK
ZIP	73663
Phone	580 922-1385
CertificateType	4
CertificateEffectiveDate	11/17/2022
CertificateExpirationDate	11/16/2024
FacilityType	Waiver

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