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General NPI Number Information
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NPI Number | 1174418859
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Entity Type | Organization
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Legal Business Name | REALM AESTHETICS
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1220 NE CROSSING STATION DRIVE SUITE 110
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City | GRIMES
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State | IA
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Zip | 50111
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Country | US
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Telephone | 515-230-7592
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 N ANKENY BLVD PO BOX 364
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City | ANKENY
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State | IA
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Zip | 50023
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Country | US
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Telephone | 515-230-7592
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Fax |
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Authorized Official
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Title or Position | FOUNDER/LEAD INJECTOR
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Name | KRYSTAL OR STEPHANIE ANN BLOMGREN
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Credential | RN
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Telephone | 515-230-7592
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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 |
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License Number State |
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