Organization Name: | CLEAR SKIN MEDICAL SOLUTIONS, LLC |
NPI Number: | 1003215955 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA ROBIN GRIFFIN (MGR/MEMBER) |
Mailing Address: | 715 W Sherman Ave Suite H Harrison |
State: | AR US |
Postal Code: | 726012743 |
Phone Number: | 8702045346 |
Fax Number: | 8703650481 |
NPI Enumeration Date: | 08/16/2014 |
NPI Last Update Date: | 08/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A001877 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |