Healthcare Provider Details

I. General information

NPI: 1073279303
Provider Name (Legal Business Name): GRACEFUL SECRETS MEDSPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 4TH ST
SAINT ANSGAR IA
50472-9606
US

IV. Provider business mailing address

4673 CAMEO AVE
SAINT ANSGAR IA
50472-8544
US

V. Phone/Fax

Practice location:
  • Phone: 507-254-8329
  • Fax: 319-409-8274
Mailing address:
  • Phone: 507-254-8329
  • Fax: 319-409-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER DIANNE NEUMANN
Title or Position: OWNER/PROVIDER
Credential: DNP
Phone: 507-254-8329