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General NPI Number Information
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NPI Number | 1467098434
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Entity Type | Organization
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Legal Business Name | D ESTHETIQUE COSMETIC &LASER CENTER
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 3916 CALLFIELD ROAD SUITE 300
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-692-1706
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Fax | 940-687-1794
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Provider Business Mailing Address
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Address Line | 3916 CALLFIELD ROAD SUITE 300
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-692-1706
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Fax | 940-687-1794
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Authorized Official
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Title or Position | BUSINESS OWNER/NURSE PRACTITIONER
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Name | REGINA MARIE HOWARD
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Credential | FAMILY NURSE PRACTIT
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Telephone | 940-692-1706
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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 |
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License Number State |
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