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General NPI Number Information
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NPI Number | 1629518832
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Entity Type | Organization
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Legal Business Name | NEW LIFE AESTHETICS P.A.
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 2091 W MILLBROOK RD STUDIO 125
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City | RALEIGH
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State | NC
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Zip | 27612-6332
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Country | US
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Telephone | 919-521-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 FILIGREE CT
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City | RALEIGH
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State | NC
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Zip | 27614-8325
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Country | US
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Telephone | 919-521-8282
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Fax |
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | MRS. MEREDITH LYNN HARRIS
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Credential | ARNP
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Telephone | 919-521-8282
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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 | NP APPROVAL 5006230
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License Number State | NC
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