Provider Demographics
NPI:1164054961
Name:ISLAND FACIAL AESTHETICS P.S.
Entity Type:Organization
Organization Name:ISLAND FACIAL AESTHETICS P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-969-0805
Mailing Address - Street 1:30 NW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3103
Mailing Address - Country:US
Mailing Address - Phone:360-678-1515
Mailing Address - Fax:360-678-5037
Practice Address - Street 1:30 NW BIRCH ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3103
Practice Address - Country:US
Practice Address - Phone:360-678-1515
Practice Address - Fax:360-678-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty