MEDICARE: NEW LIFE AESTHETICS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	NP APPROVAL 5006230	NC

General Provider Information

NPI Number	:	1629518832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE AESTHETICS P.A.

Provider Business Mailing Address
First Line	:	2308 FILIGREE CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8325
Country	:	US
Telephone Number	:	919-521-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2091 W MILLBROOK RD
Second Line	:	STUDIO 125
City	:	RALEIGH
State	:	NC
Zip	:	27612-6332
Country	:	US
Telephone Number	:	919-521-8282
Fax Number	:

Authorized Official
Title or Position	:	OWNER, NURSE PRACTITIONER
Name	:	MRS. MEREDITH LYNN HARRIS
Credential	:	ARNP
Telephone Number	:	919-521-8282

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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