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General NPI Number Information
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NPI Number | 1538867312
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Entity Type | Organization
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Legal Business Name | AESTHETIC COUTURE, PLLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 809 GREEN VALLEY RD STE 114
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City | GREENSBORO
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State | NC
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Zip | 27408-7055
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Country | US
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Telephone | 376-933-6708
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Fax |
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Provider Business Mailing Address
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Address Line | 809 GREEN VALLEY RD STE 114
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City | GREENSBORO
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State | NC
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Zip | 27408-7055
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Country | US
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Telephone | 615-708-1450
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACKLYN MARIE HALPIN
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Credential | DNP
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Telephone | 615-708-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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