Provider Demographics
NPI:1174418859
Name:REALM AESTHETICS
Entity type:Organization
Organization Name:REALM AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/LEAD INJECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL OR STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLOMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:515-230-7592
Mailing Address - Street 1:1011 N ANKENY BLVD PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:515-230-7592
Mailing Address - Fax:
Practice Address - Street 1:1220 NE CROSSING STATION DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111
Practice Address - Country:US
Practice Address - Phone:515-230-7592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center