Provider Demographics
NPI:1750660015
Name:INSTITUTE FOR PERMANENT MAKEUP AND RESTORATIVE EDUCATION
Entity Type:Organization
Organization Name:INSTITUTE FOR PERMANENT MAKEUP AND RESTORATIVE EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCTASNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-204-6500
Mailing Address - Street 1:22 SUNLIT DR E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8992
Mailing Address - Country:US
Mailing Address - Phone:505-204-6500
Mailing Address - Fax:
Practice Address - Street 1:715 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3058
Practice Address - Country:US
Practice Address - Phone:505-204-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty