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General NPI Number Information
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NPI Number | 1467171694
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Entity Type | Organization
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Legal Business Name | ACT OF BEAUTY FAMILY PRACTICE WITH AESTHETICS
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1229 TURNPIKE AVE
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City | CLEARFIELD
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State | PA
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Zip | 16830-3027
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Country | US
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Telephone | 814-592-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 TURNPIKE AVE
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City | CLEARFIELD
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State | PA
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Zip | 16830-3027
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Country | US
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Telephone | 814-592-3315
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Fax |
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Authorized Official
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Title or Position | FNP-BC
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Name | MANDY LYN GALLAHER
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Credential | RN,MSN,FNP-BC
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Telephone | 814-592-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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