Provider Demographics
NPI:1255951455
Name:NEW BEAUTIFUL YOU INC
Entity type:Organization
Organization Name:NEW BEAUTIFUL YOU INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-262-7787
Mailing Address - Street 1:1129 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2903
Mailing Address - Country:US
Mailing Address - Phone:307-234-4585
Mailing Address - Fax:307-265-7479
Practice Address - Street 1:1129 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2903
Practice Address - Country:US
Practice Address - Phone:307-234-4585
Practice Address - Fax:307-265-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center