Provider Demographics
NPI:1326752924
Name:MAGNOLIA AESTHETICS INC
Entity Type:Organization
Organization Name:MAGNOLIA AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZAKIROV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-837-5623
Mailing Address - Street 1:85 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2307
Mailing Address - Country:US
Mailing Address - Phone:781-933-3734
Mailing Address - Fax:781-932-3278
Practice Address - Street 1:550 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-837-5623
Practice Address - Fax:508-455-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2301955OtherMA LICENSE
MARN2298940OtherMA LICENSE