38D2299707 CLIA NUMBER - AUTUMN D MERCER, AGNP-C, LLC

Laboratory Demographics

CLIA Number: 38D2299707

Facility Name: AUTUMN D MERCER, AGNP-C, LLC

Facility Address:
620 N 5TH STREET
JACKSONVILLE, OR
ZIP 97530
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Facility Phone Number: 458 220-7597

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1790241065

Taxonomy: 363LA2200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	38D2299707
LAB Type	Practitioner Other
Facility Name	AUTUMN D MERCER, AGNP-C, LLC
Street	620 N 5TH STREET
City	JACKSONVILLE
State	OR
ZIP	97530
Phone	458 220-7597
CertificateType	4
CertificateEffectiveDate	2/26/2024
CertificateExpirationDate	2/25/2026
FacilityType	Waiver

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