Provider Demographics
NPI:1669209425
Name:HER FACE & BODY REJUVENATION CENTER, NURSING CORP.
Entity type:Organization
Organization Name:HER FACE & BODY REJUVENATION CENTER, NURSING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NP
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:661-449-7957
Mailing Address - Street 1:11553 FOOTHILL BLVD STE 22
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0730
Mailing Address - Country:US
Mailing Address - Phone:909-286-7846
Mailing Address - Fax:909-265-9406
Practice Address - Street 1:11553 FOOTHILL BLVD STE 22
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0730
Practice Address - Country:US
Practice Address - Phone:909-286-7846
Practice Address - Fax:909-265-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty