Provider Demographics
NPI:1467171694
Name:ACT OF BEAUTY FAMILY PRACTICE WITH AESTHETICS
Entity Type:Organization
Organization Name:ACT OF BEAUTY FAMILY PRACTICE WITH AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,FNP-BC
Authorized Official - Phone:814-592-3315
Mailing Address - Street 1:1229 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3027
Mailing Address - Country:US
Mailing Address - Phone:814-592-3315
Mailing Address - Fax:
Practice Address - Street 1:1229 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3027
Practice Address - Country:US
Practice Address - Phone:814-592-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service