46D2257891 CLIA NUMBER - GUNDERSEN FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 46D2257891
  • Facility Name: GUNDERSEN FAMILY PRACTICE
  • Facility Address: 163 SOUTH SR 112 SUITE 106
    GRANTSVILLE, UT
    ZIP 84029
  • Facility Phone: 435 264-4164
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAUN T. GUNDERSEN
  • NPI Number: 1457002503
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 46D2257891
LAB Type Physician Office
Facility Name GUNDERSEN FAMILY PRACTICE
Street 163 SOUTH SR 112 SUITE 106
City GRANTSVILLE
State UT
ZIP 84029
Phone 435 264-4164
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Physician Office
Lab Director SHAUN T. GUNDERSEN

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