Skinlab 360 Dermatology & Aesthetics LLC

NPI #1376125740 in Rexburg, Idaho

Provider Information

NPI Number: 1376125740
Entity Type: Organization
Organization Name: Skinlab 360 Dermatology & Aesthetics LLC
Primary Specialty: Physician Assistant
Enumeration Date: Apr 26, 2021
Last Updated: Apr 26, 2021

Practice Location

Address: 117 W MAIN ST STE 101
City: Rexburg
State: Idaho
ZIP Code: 83440-1826
Phone: (208) 709-0478

Authorized Official

Name: JULIE ANDERSON, PA-C
Title: OWNER
Phone: (208) 709-0478

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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