24D2293606 CLIA NUMBER - KOA HEALTH PLLC

Laboratory Demographics

  • CLIA Code: 24D2293606
  • Facility Name: KOA HEALTH PLLC
  • Facility Address: 16015 CENTRAL AVE NE SUITE A
    HAM LAKE, MN
    ZIP 55304
  • Facility Phone: 763 299-6958
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: REBECCA A. BRITTAIN
  • NPI Number: 1508543919
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2293606
LAB Type Other - CLINIC
Facility Name KOA HEALTH PLLC
Street 16015 CENTRAL AVE NE SUITE A
City HAM LAKE
State MN
ZIP 55304
Phone 763 299-6958
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type Other - CLINIC
Lab Director REBECCA A. BRITTAIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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