Provider Demographics
NPI:1902591134
Name:ADVANCED AESTHETICS AND WELLNESS
Entity Type:Organization
Organization Name:ADVANCED AESTHETICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMERTON-SPIESSCHAERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-851-9008
Mailing Address - Street 1:3150 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4612
Mailing Address - Country:US
Mailing Address - Phone:541-851-9008
Mailing Address - Fax:541-851-9114
Practice Address - Street 1:3150 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4612
Practice Address - Country:US
Practice Address - Phone:541-851-9008
Practice Address - Fax:541-851-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care