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General NPI Number Information
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NPI Number | 1124265574
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Entity Type | Organization
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Legal Business Name | AESTHETICALLY YOURS MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 919 12TH PL STE 11
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City | PRESCOTT
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State | AZ
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Zip | 86305-1433
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Country | US
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Telephone | 928-445-4272
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Fax | 928-541-9346
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Provider Business Mailing Address
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Address Line | 919 12TH PL STE 11
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City | PRESCOTT
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State | AZ
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Zip | 86305-1433
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Country | US
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Telephone | 928-445-4272
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Fax | 928-541-9346
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Authorized Official
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Title or Position | REP
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Name | MS. MARIA PARIAL
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Credential |
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Telephone | 928-443-8703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP1958
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License Number State | AZ
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