Provider Demographics
NPI:1033818976
Name:BEAUTIFUL YOU DERMATOLOGY LLC
Entity Type:Organization
Organization Name:BEAUTIFUL YOU DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WENISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DCNP
Authorized Official - Phone:319-215-5752
Mailing Address - Street 1:310 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-4616
Mailing Address - Country:US
Mailing Address - Phone:319-215-5752
Mailing Address - Fax:
Practice Address - Street 1:310 LAKE ST S
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4616
Practice Address - Country:US
Practice Address - Phone:319-215-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty