52D2111114 CLIA NUMBER - AGNESIAN DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 52D2111114
  • Facility Name: AGNESIAN DERMATOLOGY
  • Facility Address: 145 N MAIN ST ATTN JESSICA HANRAHAN
    FOND DU LAC, WI
    ZIP 54935
  • Facility Phone: 920 926-8722
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. JAMES E. SCHUSTER
  • NPI Number: 1114963261
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2111114
LAB Type Physician Office
Facility Name AGNESIAN DERMATOLOGY
Street 145 N MAIN ST ATTN JESSICA HANRAHAN
City FOND DU LAC
State WI
ZIP 54935
Phone 920 926-8722
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Physician Office
Lab Director DR. JAMES E. SCHUSTER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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