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General NPI Number Information
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NPI Number | 1588038236
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Entity Type | Organization
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Legal Business Name | AESTHETIC RECONSTRUCTIVE TATTOOS OF OHIO
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 1834 OAKLAND AVE
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2934
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Country | US
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Telephone | 740-244-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 1834 OAKLAND AVE
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City | PORTSMOUTH
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State | OH
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Zip | 45662-9310
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Country | US
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Telephone | 740-244-8266
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AMY J FLINDERS
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Credential | MSN, RN, FNP-BC
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Telephone | 740-357-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | COA 14765-NP
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License Number State | OH
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