Provider Demographics
NPI:1134861818
Name:SKIN REHAB PLLC
Entity type:Organization
Organization Name:SKIN REHAB PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SUDA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:701-379-0140
Mailing Address - Street 1:15 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2313
Mailing Address - Country:US
Mailing Address - Phone:701-379-0140
Mailing Address - Fax:701-895-5508
Practice Address - Street 1:15 E 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2313
Practice Address - Country:US
Practice Address - Phone:701-379-0140
Practice Address - Fax:701-895-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty