38D0625580 CLIA NUMBER - WILLAMETTE UROLOGY PC LABORATORY

Laboratory Demographics

CLIA Number: 38D0625580

Facility Name: WILLAMETTE UROLOGY PC LABORATORY

Facility Address:
2973 12TH STREET SE
SALEM, OR
ZIP 97302
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Facility Phone Number: 503 561-7100

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1730636762

Taxonomy: 164W00000X - Licensed Practical Nurse
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

CLIA Record

Field Name	Field Value
CLIA Number	38D0625580
LAB Type	Physician Office
Facility Name	WILLAMETTE UROLOGY PC LABORATORY
Street	2973 12TH STREET SE
City	SALEM
State	OR
ZIP	97302
Phone	503 561-7100
CertificateType	2
CertificateEffectiveDate	12/5/2022
CertificateExpirationDate	12/4/2024
FacilityType	Compliance

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