44D2241396 CLIA NUMBER - VITA-INFUSION AND WELLNESS

Laboratory Demographics

CLIA Number: 44D2241396

Facility Name: VITA-INFUSION AND WELLNESS

Facility Address:
810 DOMINICAN DRIVE FILMHOUSE BUILDING, SUITE 112
NASHVILLE, TN
ZIP 37228
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Facility Phone Number: 615 928-2351

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1659040285

Taxonomy: 363LA2200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	44D2241396
LAB Type	Practitioner Other
Facility Name	VITA-INFUSION AND WELLNESS
Street	810 DOMINICAN DRIVE FILMHOUSE BUILDING, SUITE 112
City	NASHVILLE
State	TN
ZIP	37228
Phone	615 928-2351
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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