Provider Demographics
NPI:1871018325
Name:BEAUTIFULLY SCARRED,LLC
Entity Type:Organization
Organization Name:BEAUTIFULLY SCARRED,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ESTHETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:QIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPP
Authorized Official - Suffix:
Authorized Official - Credentials:ESTHETICIAN
Authorized Official - Phone:419-322-0567
Mailing Address - Street 1:6924 SPRING VALLEY DR STE 160
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6924 SPRING VALLEY DR STE 160
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9482
Practice Address - Country:US
Practice Address - Phone:419-322-0567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-06
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHESTE-170641207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty