Provider Demographics
NPI:1053583690
Name:SKINSATIONS DERMATHERAPY, LLC
Entity type:Organization
Organization Name:SKINSATIONS DERMATHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:765-377-7039
Mailing Address - Street 1:746 NORTHSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2583
Mailing Address - Country:US
Mailing Address - Phone:765-377-7039
Mailing Address - Fax:765-377-7189
Practice Address - Street 1:746 NORTHSIDE CT
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2583
Practice Address - Country:US
Practice Address - Phone:765-377-7039
Practice Address - Fax:765-377-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027519A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center