Provider Demographics
NPI:1013804400
Name:ISLAND LIFE AESTHETICS AND WELLNESS
Entity type:Organization
Organization Name:ISLAND LIFE AESTHETICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-992-6700
Mailing Address - Street 1:515 FLAT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-7968
Mailing Address - Country:US
Mailing Address - Phone:859-992-6700
Mailing Address - Fax:
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8488
Practice Address - Country:US
Practice Address - Phone:859-379-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1659777985OtherINDIVIDUAL NPI