Provider Demographics
NPI:1861367781
Name:CANVAS & GLOW AESTHETIQ, PC
Entity type:Organization
Organization Name:CANVAS & GLOW AESTHETIQ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:CHILDERS
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:704-951-4569
Mailing Address - Street 1:9710 SAM FURR RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4928
Mailing Address - Country:US
Mailing Address - Phone:704-951-4569
Mailing Address - Fax:980-288-4569
Practice Address - Street 1:9710 SAM FURR RD UNIT E
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4928
Practice Address - Country:US
Practice Address - Phone:704-951-4569
Practice Address - Fax:980-288-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty