Provider Demographics
NPI:1679375018
Name:KANVAS WELLNESS AND AESTHETICS, LLC
Entity type:Organization
Organization Name:KANVAS WELLNESS AND AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:908-329-4400
Mailing Address - Street 1:760 E MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2692
Mailing Address - Country:US
Mailing Address - Phone:615-706-0093
Mailing Address - Fax:931-443-0174
Practice Address - Street 1:760 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2692
Practice Address - Country:US
Practice Address - Phone:615-706-0093
Practice Address - Fax:931-443-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care