35D1061484 CLIA NUMBER - LILLESTOL RESEARCH LLC

Laboratory Demographics

  • CLIA Code: 35D1061484
  • Facility Name: LILLESTOL RESEARCH LLC
  • Facility Address: 4450 31ST AVE S, SUITE 101
    FARGO, ND
    ZIP 58104
  • Facility Phone: 701 232-7705
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. LILLESTOL
  • NPI Number: 1104108695
  • Taxonomy: 363L00000X - Nurse Practitioner

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2024
Certificate Expiration Date 11/19/2026
Facility Type Independent
Lab Director MICHAEL J. LILLESTOL

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