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General NPI Number Information
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NPI Number | 1568357465
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Entity Type | Organization
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Legal Business Name | ETERNA AESTHETIC AND WELLNESS
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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 | 2 CARRIAGE LN
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City | CHARLESTON
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State | SC
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Zip | 29407-6010
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Country | US
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Telephone | 843-571-3100
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Fax | 843-766-7798
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Provider Business Mailing Address
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Address Line | 2 CARRIAGE LN
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City | CHARLESTON
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State | SC
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Zip | 29407-6010
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Country | US
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Telephone | 843-571-3100
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Fax | 843-766-7798
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Authorized Official
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Title or Position | CO-OWNER
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Name | JESSICA LUCKIE
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Credential |
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Telephone | 843-225-9810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 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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