Healthcare Provider Details

I. General information

NPI: 1154921179
Provider Name (Legal Business Name): ADVANCED SKIN CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ELLIOT ST
BRATTLEBORO VT
05301-3209
US

IV. Provider business mailing address

112 OLD COACH RD
DUMMERSTON VT
05301-9527
US

V. Phone/Fax

Practice location:
  • Phone: 267-738-5078
  • Fax:
Mailing address:
  • Phone: 267-738-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MARY ELIZABETH FREIHOFNER
Title or Position: OWNER
Credential:
Phone: 267-738-5078