24D2275894 CLIA NUMBER - MINNESOTA'S MIRACLE LLC

Laboratory Demographics

  • CLIA Code: 24D2275894
  • Facility Name: MINNESOTA'S MIRACLE LLC
  • Facility Address: 17645 JUNIPER PATH
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 763 280-0419
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: RACHAEL F. PICKETT THEEL
  • NPI Number: 1801548748
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 24D2275894
LAB Type Practitioner Other
Facility Name MINNESOTA'S MIRACLE LLC
Street 17645 JUNIPER PATH
City LAKEVILLE
State MN
ZIP 55044
Phone 763 280-0419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Practitioner Other
Lab Director RACHAEL F. PICKETT THEEL

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