Healthcare Provider Details

I. General information

NPI: 1629518832
Provider Name (Legal Business Name): NEW LIFE AESTHETICS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 W MILLBROOK RD STUDIO 125
RALEIGH NC
27612-6332
US

IV. Provider business mailing address

2308 FILIGREE CT
RALEIGH NC
27614-8325
US

V. Phone/Fax

Practice location:
  • Phone: 919-521-8282
  • Fax:
Mailing address:
  • Phone: 919-521-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberNP APPROVAL 5006230
License Number StateNC

VIII. Authorized Official

Name: MRS. MEREDITH LYNN HARRIS
Title or Position: OWNER, NURSE PRACTITIONER
Credential: ARNP
Phone: 919-521-8282