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General NPI Number Information
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NPI Number | 1053583690
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Entity Type | Organization
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Legal Business Name | SKINSATIONS DERMATHERAPY, LLC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 746 NORTHSIDE CT
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2583
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Country | US
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Telephone | 765-377-7039
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Fax | 765-377-7189
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Provider Business Mailing Address
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Address Line | 746 NORTHSIDE CT
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2583
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Country | US
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Telephone | 765-377-7039
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Fax | 765-377-7189
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Authorized Official
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Title or Position | OWNER
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Name | MS. APRIL ANN SMALLWOOD
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Credential | LPN
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Telephone | 765-377-7039
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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 | 01027519A
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License Number State | IN
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