Healthcare Provider Details

I. General information

NPI: 1366292096
Provider Name (Legal Business Name): AURAE MEDSPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 SHUCKER CIR STE 1120
MOUNT PLEASANT SC
29464-4978
US

IV. Provider business mailing address

PO BOX 1779
MOUNT PLEASANT SC
29465-1779
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-6788
  • Fax:
Mailing address:
  • Phone: 843-212-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA GLASER
Title or Position: CEO
Credential: DNP, APRN, FNP-BC
Phone: 843-212-6788