Provider Demographics
NPI:1215522644
Name:NEW SKIN MEDICAL SPA AND AESTHETICS
Entity type:Organization
Organization Name:NEW SKIN MEDICAL SPA AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP, MSN
Authorized Official - Phone:714-328-4288
Mailing Address - Street 1:476 ROCHELLE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2044
Mailing Address - Country:US
Mailing Address - Phone:714-328-4288
Mailing Address - Fax:
Practice Address - Street 1:476 ROCHELLE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2044
Practice Address - Country:US
Practice Address - Phone:714-328-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center