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General NPI Number Information
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NPI Number | 1609535251
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Entity Type | Organization
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Legal Business Name | BEAUTY MARK AESTHETICS
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 866 E FRANKLIN ST STE C
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City | CENTERVILLE
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State | OH
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Zip | 45459-5608
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Country | US
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Telephone | 937-867-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 DEER CRK
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City | MIDDLETOWN
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State | OH
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Zip | 45042-5805
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Country | US
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Telephone | 937-867-7700
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | SHELBY GONSALES
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Credential | APRN
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Telephone | 937-867-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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