Basic Information
| Provider Information | |||||||||
| NPI: | 1649560236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | URBAN EFFECTS MEDSPA INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2480 BERKSHIRE PKWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503254683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159875188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2480 BERKSHIRE PKWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503254683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159875188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2011 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | CALHOUN | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5159875188 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A-059121 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.