Provider Demographics
NPI:1629518832
Name:NEW LIFE AESTHETICS P.A.
Entity Type:Organization
Organization Name:NEW LIFE AESTHETICS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:919-521-8282
Mailing Address - Street 1:2308 FILIGREE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8325
Mailing Address - Country:US
Mailing Address - Phone:919-521-8282
Mailing Address - Fax:
Practice Address - Street 1:2091 W MILLBROOK RD
Practice Address - Street 2:STUDIO 125
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6332
Practice Address - Country:US
Practice Address - Phone:919-521-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNP APPROVAL 5006230261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center