Healthcare Provider Details

I. General information

NPI: 1245889898
Provider Name (Legal Business Name): TOTAL SKIN DERMATOLOGY & AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4571 S WASHINGTON ST STE N
GRAND FORKS ND
58201-7218
US

IV. Provider business mailing address

1711 KINGS VIEW DR
GRAND FORKS ND
58201-9281
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-3376
  • Fax:
Mailing address:
  • Phone: 701-740-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LAFRAMBOISE
Title or Position: OWNER
Credential: FNP-BC, DCNP
Phone: 701-740-6572