Healthcare Provider Details

I. General information

NPI: 1750660015
Provider Name (Legal Business Name): INSTITUTE FOR PERMANENT MAKEUP AND RESTORATIVE EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S SAINT FRANCIS DR
SANTA FE NM
87505-3058
US

IV. Provider business mailing address

22 SUNLIT DR E
SANTA FE NM
87508-8992
US

V. Phone/Fax

Practice location:
  • Phone: 505-204-6500
  • Fax:
Mailing address:
  • Phone: 505-204-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEANINE G MCTASNEY
Title or Position: OWNER
Credential:
Phone: 505-204-6500