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General NPI Number Information
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NPI Number | 1548794175
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Entity Type | Organization
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Legal Business Name | RESTORATION LAB SERVICES LLC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 3805 WASHINGTON AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55412-2141
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Country | US
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Telephone | 612-677-2668
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Fax | 612-767-6603
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Provider Business Mailing Address
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Address Line | 3805 WASHINGTON AVENUE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55412-1714
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Country | US
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Telephone | 612-767-9525
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MRS. ROBIN MCKERNAN
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Credential | B.S.
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Telephone | 612-767-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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