Healthcare Provider Details

I. General information

NPI: 1538019484
Provider Name (Legal Business Name): AETERNA AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 TYLERS CORNER DR STE B
WEST CHESTER OH
45069-6335
US

IV. Provider business mailing address

7242 TYLERS CORNER DR STE B
WEST CHESTER OH
45069-6335
US

V. Phone/Fax

Practice location:
  • Phone: 513-644-9164
  • Fax: 513-644-9164
Mailing address:
  • Phone: 513-644-9164
  • Fax: 513-644-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE SNOKE
Title or Position: OWNER
Credential:
Phone: 513-644-9164