Provider Demographics
NPI:1275998692
Name:SKINSPA LLC
Entity Type:Organization
Organization Name:SKINSPA LLC
Other - Org Name:SKINGYM BY ASHLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ZETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-870-2780
Mailing Address - Street 1:9350 UNIVERSITY AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1648
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:9350 UNIVERSITY AVE STE 132
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1648
Practice Address - Country:US
Practice Address - Phone:801-870-2780
Practice Address - Fax:515-288-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty