Healthcare Provider Details

I. General information

NPI: 1215604699
Provider Name (Legal Business Name): LANETIA'S MASSAGE AND SKIN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 W 10TH ST
INDIANAPOLIS IN
46224-6200
US

IV. Provider business mailing address

13313 N ETNA GREEN DR
CAMBY IN
46113-8351
US

V. Phone/Fax

Practice location:
  • Phone: 317-319-8092
  • Fax:
Mailing address:
  • Phone: 317-319-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: LANETIA JO WOOLDRIDGE
Title or Position: OWNER
Credential:
Phone: 317-319-8092