Provider Demographics
NPI:1629720511
Name:ZG WELLNESS AND DERMATOLOGY
Entity Type:Organization
Organization Name:ZG WELLNESS AND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:REUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-344-3250
Mailing Address - Street 1:2853 TOWN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2412
Mailing Address - Country:US
Mailing Address - Phone:859-344-3250
Mailing Address - Fax:
Practice Address - Street 1:2853 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2412
Practice Address - Country:US
Practice Address - Phone:859-344-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty