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General NPI Number Information
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NPI Number | 1730757824
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Entity Type | Organization
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Legal Business Name | LAB TEAM ASSISTANTS, LLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 849 W 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1027
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Country | US
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Telephone | 612-547-5754
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Fax |
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Provider Business Mailing Address
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Address Line | 849 W 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1027
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Country | US
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Telephone | 612-547-5754
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | LISA WYLIE
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Credential | CPT, MA
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Telephone | 612-547-5754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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