Provider Demographics
NPI:1316566888
Name:AUBURN PRIMARY CARE AND AESTHETIC S
Entity Type:Organization
Organization Name:AUBURN PRIMARY CARE AND AESTHETIC S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IWONA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABUCKA-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-796-9211
Mailing Address - Street 1:489 WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:508-796-9211
Mailing Address - Fax:508-286-6106
Practice Address - Street 1:489 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5709
Practice Address - Country:US
Practice Address - Phone:508-796-9211
Practice Address - Fax:508-286-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty