| NPI | 1477250991 |
|---|---|
| Doing Business As | BEAUTIQUE SPA LLC |
| Entity Type | Organization |
| Authorized Contact | TRICIA-KAY ELLERSICK-LOPEZ Owner 570-807-3034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-02-15 |