52D2149050 CLIA NUMBER - VILLAGE PRIMARY CARE PROVIDERS LLC

Laboratory Demographics

CLIA Number: 52D2149050

Facility Name: VILLAGE PRIMARY CARE PROVIDERS LLC

Facility Address:
1111 DELAFIELD STREET STE 327
WAUKESHA, WI
ZIP 53188
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Facility Phone Number: 262 875-4892

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003324617

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	52D2149050
LAB Type	Physician Office
Facility Name	VILLAGE PRIMARY CARE PROVIDERS LLC
Street	1111 DELAFIELD STREET STE 327
City	WAUKESHA
State	WI
ZIP	53188
Phone	262 875-4892
CertificateType	4
CertificateEffectiveDate	5/23/2022
CertificateExpirationDate	5/22/2024
FacilityType	Waiver

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