38D2270000 CLIA NUMBER - REVITALIZED WELLNESS PLLC

Laboratory Demographics

  • CLIA Code: 38D2270000
  • Facility Name: REVITALIZED WELLNESS PLLC
  • Facility Address: 71 CENTENNIAL LOOP STE A
    EUGENE, OR
    ZIP 97401
  • Facility Phone: 541 214-2786
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KRISTI L. ROSS
  • NPI Number: 1760093025
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2270000
LAB Type Practitioner Other
Facility Name REVITALIZED WELLNESS PLLC
Street 71 CENTENNIAL LOOP STE A
City EUGENE
State OR
ZIP 97401
Phone 541 214-2786
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2024
Certificate Expiration Date 10/5/2026
Facility Type Practitioner Other
Lab Director KRISTI L. ROSS

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