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General NPI Number Information
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NPI Number | 1154895209
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Entity Type | Organization
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Legal Business Name | SKIN ENVY DERMATOLOGY
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 3140 ELK LN STE 600
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City | FREMONT
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State | NE
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Zip | 68025-8650
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Country | US
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Telephone | 402-936-6198
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Fax | 402-816-4402
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Provider Business Mailing Address
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Address Line | 3140 ELK LN STE 600
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City | FREMONT
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State | NE
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Zip | 68025-8650
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Country | US
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Telephone | 402-936-6198
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Fax |
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Authorized Official
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Title or Position | OWNER/NP
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Name | DEBRA LYNN BAKER
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Credential | NP
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Telephone | 402-936-6198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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