Provider Demographics
NPI:1326856428
Name:JUNIPER REJUVENATION, LLC
Entity type:Organization
Organization Name:JUNIPER REJUVENATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CALURE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-598-4165
Mailing Address - Street 1:1028 N CHUSI WAY
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6722
Mailing Address - Country:US
Mailing Address - Phone:410-598-4165
Mailing Address - Fax:
Practice Address - Street 1:1028 N CHUSI WAY
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6722
Practice Address - Country:US
Practice Address - Phone:410-598-4165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center