Healthcare Provider Details

I. General information

NPI: 1073441648
Provider Name (Legal Business Name): NEA ELECTROLYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 GRANT AVE STE H
JONESBORO AR
72401-6198
US

IV. Provider business mailing address

33 BROADWAY CV APT 10
MAYNARD AR
72444-9201
US

V. Phone/Fax

Practice location:
  • Phone: 262-227-2576
  • Fax:
Mailing address:
  • Phone: 262-227-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN DILDINE
Title or Position: LICENSED ELECTROLOGIST
Credential:
Phone: 262-227-2576