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General NPI Number Information
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NPI Number | 1013804400
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Entity Type | Organization
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Legal Business Name | ISLAND LIFE AESTHETICS AND WELLNESS
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 102 N MAIN ST
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City | CRITTENDEN
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State | KY
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Zip | 41030-8488
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Country | US
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Telephone | 859-379-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 515 FLAT CREEK RD
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City | DRY RIDGE
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State | KY
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Zip | 41035-7968
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Country | US
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Telephone | 859-992-6700
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DOLORES HOLTMANN
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Credential | APRN
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Telephone | 859-992-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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