Provider Demographics
NPI:1033736210
Name:SKYROSE REJUVENATION CLINIC & SPA LLC
Entity Type:Organization
Organization Name:SKYROSE REJUVENATION CLINIC & SPA LLC
Other - Org Name:HEALTHCARE, ESTHETIC PROCEDURES
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHAKIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:773-558-9597
Mailing Address - Street 1:22544 CRESCENT WAY
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1861
Mailing Address - Country:US
Mailing Address - Phone:773-558-9597
Mailing Address - Fax:
Practice Address - Street 1:9021 W 151ST ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3201
Practice Address - Country:US
Practice Address - Phone:708-966-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty