Provider Demographics
NPI:1215604699
Name:LANETIA'S MASSAGE AND SKIN CARE
Entity Type:Organization
Organization Name:LANETIA'S MASSAGE AND SKIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANETIA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-319-8092
Mailing Address - Street 1:13313 N ETNA GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8351
Mailing Address - Country:US
Mailing Address - Phone:317-319-8092
Mailing Address - Fax:
Practice Address - Street 1:5550 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6200
Practice Address - Country:US
Practice Address - Phone:317-319-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date: