Provider Demographics
NPI:1841034055
Name:TRUE DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:TRUE DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PA10004052
Authorized Official - Phone:509-438-0295
Mailing Address - Street 1:7101 W HOOD PL STE A101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6720
Mailing Address - Country:US
Mailing Address - Phone:509-581-3100
Mailing Address - Fax:
Practice Address - Street 1:7101 W HOOD PL STE A101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6720
Practice Address - Country:US
Practice Address - Phone:509-581-3100
Practice Address - Fax:509-436-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty