50D2316103 CLIA NUMBER - ST PHILOMENA AFH LLC

Laboratory Demographics

  • CLIA Code: 50D2316103
  • Facility Name: ST PHILOMENA AFH LLC
  • Facility Address: 5522 90TH PL NE
    MARYSVILLE, WA
    ZIP 98270
  • Facility Phone: 360 691-9482
  • Facility Type: Other - AFH
  • Facility Type: Waiver
  • Lab Director: ESTHER MITEMA
  • NPI Number: 1104646934
  • Taxonomy: 163W00000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 50D2316103
LAB Type Other - AFH
Facility Name ST PHILOMENA AFH LLC
Street 5522 90TH PL NE
City MARYSVILLE
State WA
ZIP 98270
Phone 360 691-9482
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 4/4/2028
Facility Type Other - AFH
Lab Director ESTHER MITEMA

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