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1174418859 NPI number — REALM AESTHETICS

NPI Number: 1174418859
Health Care Provider/Practitioner: REALM AESTHETICS

Information about “1174418859” NPI (REALM AESTHETICS) exists in 1174418859 in HTML format HTML  |  1174418859 in plain Text format TXT  |  1174418859 in PDF (Portable Document Format) PDF  |  1174418859 in an XML format XML  formats.

NPI Number : 1174418859 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174418859",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REALM AESTHETICS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1011 N ANKENY BLVD PO BOX 364",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANKENY",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50023",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "515-230-7592",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1220 NE CROSSING STATION DRIVE",
    "SecondLinePracticeLocationAddress": "SUITE 110",
    "PracticeLocationAddressCityName": "GRIMES",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50111",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "515-230-7592",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/11/2025",
    "LastUpdateDate": "06/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BLOMGREN",
    "AuthorizedOfficialFirstName": "KRYSTAL OR STEPHANIE",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "FOUNDER/LEAD INJECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "515-230-7592",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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