Healthcare Provider Details

I. General information

NPI: 1427774330
Provider Name (Legal Business Name): ADVANCED CENTER FOR ELECTROLYSIS & LASER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 NORTHLAND CT NE
CEDAR RAPIDS IA
52402-6226
US

IV. Provider business mailing address

216 NORTHLAND CT NE
CEDAR RAPIDS IA
52402-6226
US

V. Phone/Fax

Practice location:
  • Phone: 319-447-2500
  • Fax:
Mailing address:
  • Phone: 319-447-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGELA FLENDER
Title or Position: PRESIDENT/OWNER
Credential: LE
Phone: 319-447-2500