Healthcare Provider Details

I. General information

NPI: 1053234047
Provider Name (Legal Business Name): DERMQUEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E CHESTNUT ST
LANCASTER OH
43130-3900
US

IV. Provider business mailing address

609 E CHESTNUT ST
LANCASTER OH
43130-3900
US

V. Phone/Fax

Practice location:
  • Phone: 740-206-7131
  • Fax: 740-422-0711
Mailing address:
  • Phone: 740-206-7131
  • Fax: 740-422-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE RENKO
Title or Position: OWNER
Credential: NP
Phone: 740-331-1853