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General NPI Number Information
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NPI Number | 1861372989
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Entity Type | Organization
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Legal Business Name | NEOLAILA BEAUTY DBA ADVANCED ANTI-AGING CENTER OF EXCELLENCE
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 5401 VOGEL RD STE 630
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City | EVANSVILLE
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State | IN
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Zip | 47715-7835
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Country | US
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Telephone | 812-483-7153
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Fax | 812-303-4500
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Provider Business Mailing Address
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Address Line | 5401 VOGEL RD STE 630
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City | EVANSVILLE
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State | IN
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Zip | 47715-7835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | IRINA KOCHERSPERGER
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Credential |
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Telephone | 812-483-7153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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