37D2237166 CLIA NUMBER - RIVER WOLF GYNECOLOGY & FAMILY HEALTH, PLLC

Laboratory Demographics

CLIA Number: 37D2237166

Facility Name: RIVER WOLF GYNECOLOGY & FAMILY HEALTH, PLLC

Facility Address:
2104 BANBURY LANE
OKLAHOMA CITY, OK
ZIP 73170
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Facility Phone Number: 405 203-5382

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1205408481

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	37D2237166
LAB Type	Physician Office
Facility Name	RIVER WOLF GYNECOLOGY & FAMILY HEALTH, PLLC
Street	2104 BANBURY LANE
City	OKLAHOMA CITY
State	OK
ZIP	73170
Phone	405 203-5382
CertificateType	3
CertificateEffectiveDate	9/23/2023
CertificateExpirationDate	9/22/2025
FacilityType	PPMP

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