Provider Demographics
NPI:1932877909
Name:REJUVENATION SKIN WELLNESS AND AESTHETICS
Entity Type:Organization
Organization Name:REJUVENATION SKIN WELLNESS AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:DEMPSEY
Authorized Official - Last Name:DONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:302-537-8318
Mailing Address - Street 1:35202 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6901
Mailing Address - Country:US
Mailing Address - Phone:302-537-8318
Mailing Address - Fax:
Practice Address - Street 1:35202 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6901
Practice Address - Country:US
Practice Address - Phone:302-537-8318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care