52D2321783 CLIA NUMBER - AETERNA LIFE

Laboratory Demographics

  • CLIA Code: 52D2321783
  • Facility Name: AETERNA LIFE
  • Facility Address: 7505 W THURSTON AVENUE
    MILWAUKEE, WI
    ZIP 53218
  • Facility Phone: 414 403-5567
  • Facility Type: Other - MOBILE PHLEBOTOMY SERVICE
  • Facility Type: Waiver
  • Lab Director: MAYA N. WESTMORELAND
  • NPI Number: 1275336919
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2321783
LAB Type Other - MOBILE PHLEBOTOMY SERVICE
Facility Name AETERNA LIFE
Street 7505 W THURSTON AVENUE
City MILWAUKEE
State WI
ZIP 53218
Phone 414 403-5567
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 Other - MOBILE PHLEBOTOMY SERVICE
Lab Director MAYA N. WESTMORELAND

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