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General NPI Number Information
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NPI Number | 1528608288
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Entity Type | Organization
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Legal Business Name | ELECTROLYSIS AND ESTHETIC BY JOANNE
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 723 SE MAIN ST
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City | ROSEBURG
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State | OR
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Zip | 97470-3938
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Country | US
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Telephone | 541-670-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 1183 NW RIVERFRONT DR
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City | ROSEBURG
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State | OR
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Zip | 97471-6168
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Country | US
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Telephone | 541-670-8401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOANNE CLARKE
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Credential | L.E.
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Telephone | 541-670-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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