Provider Demographics
NPI:1518591163
Name:TRUE REJUVENATION PEPTIDE AND HORMONE REPLACEMENT THERAPY PLLC
Entity Type:Organization
Organization Name:TRUE REJUVENATION PEPTIDE AND HORMONE REPLACEMENT THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:814-812-1012
Mailing Address - Street 1:4125 W RIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1763
Mailing Address - Country:US
Mailing Address - Phone:814-520-6144
Mailing Address - Fax:814-520-6420
Practice Address - Street 1:4125 W RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1763
Practice Address - Country:US
Practice Address - Phone:814-520-6144
Practice Address - Fax:814-520-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care