Provider Demographics
NPI:1598544033
Name:MED SPA AT SKIN MPLS PLLC
Entity Type:Organization
Organization Name:MED SPA AT SKIN MPLS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-817-5090
Mailing Address - Street 1:5100 EDINA INDUSTRIAL BLVD STE 238
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD STE 238
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3003
Practice Address - Country:US
Practice Address - Phone:612-817-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center