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General NPI Number Information
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NPI Number | 1063151736
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Entity Type | Organization
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Legal Business Name | PLATINUM COSMETICS
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 111 1ST ST NE STE A
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City | LITTLE FALLS
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State | MN
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Zip | 56345-2601
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Country | US
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Telephone | 320-639-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 111 1ST ST NE STE A
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City | LITTLE FALLS
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State | MN
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Zip | 56345-2601
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Country | US
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Telephone | 320-639-1230
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MICHELLE MATTISON
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Credential | NURSE PRACTITIONER
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Telephone | 320-431-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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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 | 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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