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General NPI Number Information
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NPI Number | 1780110130
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Entity Type | Organization
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Legal Business Name | TERI SEVERSON ELECTROLYSIS
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 701 HIGH ST SUITE 201
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City | AUBURN
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State | CA
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Zip | 95603-4735
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Country | US
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Telephone | 916-267-1377
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Fax |
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Provider Business Mailing Address
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Address Line | 701 HIGH ST SUITE 201
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City | AUBURN
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State | CA
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Zip | 95603-4735
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Country | US
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Telephone | 916-267-1377
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | TERI SEVERSON
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Credential | L.E.
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Telephone | 916-267-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | L9307
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License Number State | CA
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