Healthcare Provider Details

I. General information

NPI: 1649560236
Provider Name (Legal Business Name): URBAN EFFECTS MEDSPA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 BERKSHIRE PKWY SUITE B
CLIVE IA
50325-4683
US

IV. Provider business mailing address

2480 BERKSHIRE PKWY SUITE B
CLIVE IA
50325-4683
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-5188
  • Fax:
Mailing address:
  • Phone: 515-987-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-059121
License Number StateIA

VIII. Authorized Official

Name: MS. JANET CALHOUN
Title or Position: PRESIDENT
Credential:
Phone: 515-987-5188