Provider Demographics
NPI:1326811571
Name:PERMANENT MAKE UP ARTS
Entity Type:Organization
Organization Name:PERMANENT MAKE UP ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYBOTH - MALMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-574-8383
Mailing Address - Street 1:236 CRETIN AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1259
Mailing Address - Country:US
Mailing Address - Phone:612-332-0142
Mailing Address - Fax:
Practice Address - Street 1:236 CRETIN AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1259
Practice Address - Country:US
Practice Address - Phone:612-332-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty