Healthcare Provider Details

I. General information

NPI: 1467171694
Provider Name (Legal Business Name): ACT OF BEAUTY FAMILY PRACTICE WITH AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 TURNPIKE AVE
CLEARFIELD PA
16830-3027
US

IV. Provider business mailing address

1229 TURNPIKE AVE
CLEARFIELD PA
16830-3027
US

V. Phone/Fax

Practice location:
  • Phone: 814-592-3315
  • Fax:
Mailing address:
  • Phone: 814-592-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MANDY LYN GALLAHER
Title or Position: FNP-BC
Credential: RN,MSN,FNP-BC
Phone: 814-592-3315