Become A ProviderPlease enable JavaScript in your browser to complete this form.Clinic / Group *Name *FirstLastCredentialsNDNMDMD...SpecialtyCardiologyDermatologyHematology...License *NPILicense Expiry *License Country *License State *Application Filled Out By: *Email *Certification *YesNoI Don't KnowI certify that it is within my scope of practice and interpret laboratory tests according to the regulation set forth by my state for my license. I AM A STUDENTPlease Note *FaxEmailA copy of your professional license/certificate must be sent to Diagnostechs for verification via fax (425-656-2871 or email (accounts@diagnostechs.com). Please indicate which method of transmittal you will use: Submit Username or Email Address Password Remember Me Forgot password?