Provider Demographics
NPI:1073279303
Name:GRACEFUL SECRETS MEDSPA
Entity Type:Organization
Organization Name:GRACEFUL SECRETS MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:507-254-8329
Mailing Address - Street 1:4673 CAMEO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-8544
Mailing Address - Country:US
Mailing Address - Phone:507-254-8329
Mailing Address - Fax:319-409-8274
Practice Address - Street 1:204 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-9606
Practice Address - Country:US
Practice Address - Phone:507-254-8329
Practice Address - Fax:319-409-8274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUMANN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service