# SKINLAB 360 DERMATOLOGY & AESTHETICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376125740
- **Authorized official:** JULIE ANDERSON PA-C (OWNER)
- **Authorized official phone:** (208) 709-0478

## Contact information

- **Practice address:** 117 W MAIN ST STE 101, REXBURG, ID 83440-1826
- **Practice address phone:** (208) 709-0478
- **Mailing address:** PO BOX 3625, IDAHO FALLS, ID 83403-3625
- **Mailing address phone:** (800) 338-5378
- **Mailing address fax:** (208) 523-8978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2021
- **Last updated:** 04/26/2021