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PRESTIGE AESTHETICS AND HYDRATION LOUNGE NPI 1720774938


NPI Information

NPI: 1720774938
Provider Name: PRESTIGE AESTHETICS AND HYDRATION LOUNGE

Other Name: PRESTIGE AESTHETICS AND HYDRATION LOUNGE

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1761 N DILLEYS RD STE 108-9
GURNEE, IL
ZIP 60031
Phone: (720) 343-9979
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PRESTIGE AESTHETICS AND HYDRATION LOUNGE is a family nurse practitioner in Gurnee, IL. PRESTIGE AESTHETICS AND HYDRATION LOUNGE NPI is 1720774938. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Prestige Aesthetics And Hydration Lounge.

The provider's business location address is:

1761 N DILLEYS RD STE 108-9
GURNEE, IL
ZIP 60031-711
Phone: (720) 343-9979

The provider's authorized official is Diesawit T Hansom .
The authorized official title is Fnp and has the following contact phone number (720) 343-9799.

The enumeration date for this NPI number is 4/12/2023 and was last updated on 6/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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