07D2274619 CLIA NUMBER - COLLABORATIVE MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 07D2274619
  • Facility Name: COLLABORATIVE MEDICINE LLC
  • Facility Address: 166 ALBANY TURNPIKE, STE 7
    CANTON, CT
    ZIP 06019
  • Facility Phone: 860 935-6680
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JENNIFER CANNON APRN
  • NPI Number: 1063137511
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 07D2274619
LAB Type Practitioner Other
Facility Name COLLABORATIVE MEDICINE LLC
Street 166 ALBANY TURNPIKE, STE 7
City CANTON
State CT
ZIP 06019
Phone 860 935-6680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Practitioner Other
Lab Director JENNIFER CANNON APRN

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This page was last updated on: 6/4/2025