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General NPI Number Information
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NPI Number | 1043918238
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Entity Type | Organization
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Legal Business Name | SKINOVATION ADVANCED AESTHETICS
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 600 JULIAN LN
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City | ARDEN
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State | NC
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Zip | 28704-7813
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Country | US
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Telephone | 828-551-2442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | DENVER
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State | NC
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Zip | 28037-0188
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Country | US
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Telephone | 828-551-2442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WENDI LONABAUGH
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Credential | DNP, FNP-BC
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Telephone | 828-279-5829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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