35D1061484 CLIA NUMBER - LILLESTOL RESEARCH LLC

Laboratory Demographics

CLIA Number: 35D1061484

Facility Name: LILLESTOL RESEARCH LLC

Facility Address:
4450 31ST AVE S, SUITE 101
FARGO, ND
ZIP 58104
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Facility Phone Number: 701 232-7705

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1104108695

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	35D1061484
LAB Type	Independent
Facility Name	LILLESTOL RESEARCH LLC
Street	4450 31ST AVE S, SUITE 101
City	FARGO
State	ND
ZIP	58104
Phone	701 232-7705
CertificateType	4
CertificateEffectiveDate	11/20/2022
CertificateExpirationDate	11/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024