Provider Demographics
NPI:1508294976
Name:ADVANCED IMAGE ARTISTRY, INC.
Entity Type:Organization
Organization Name:ADVANCED IMAGE ARTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:413-822-1776
Mailing Address - Street 1:137 NORTH ST
Mailing Address - Street 2:#208
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-822-1776
Mailing Address - Fax:
Practice Address - Street 1:137 NORTH ST.
Practice Address - Street 2:#208
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-822-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233186163W00000X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Multi-Specialty