52D2321775 CLIA NUMBER - NOVA INTEGRATED CARE

Laboratory Demographics

  • CLIA Code: 52D2321775
  • Facility Name: NOVA INTEGRATED CARE
  • Facility Address: 302 WEST PINE ST SUITE 2
    EAGLE RIVER, WI
    ZIP 54521
  • Facility Phone: 715 890-4122
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JILL K. BRUNSTAD
  • NPI Number: 1679355358
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2321775
LAB Type Physician Office
Facility Name NOVA INTEGRATED CARE
Street 302 WEST PINE ST SUITE 2
City EAGLE RIVER
State WI
ZIP 54521
Phone 715 890-4122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Physician Office
Lab Director JILL K. BRUNSTAD

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