Organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Active
Parent organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Other names
Divine Dermatology and Surgical Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Authorized official
JENNIFER MICHELLE DIVINE (OWNER)
(970) 286-2668
Entity
Organization
Contact information
Practice address
1327 EAGLE DR, LOVELAND, CO 80537-8059
(970) 286-2668
Mailing address
1327 EAGLE DR, LOVELAND, CO 80537-8059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
03/14/2020
Last updated
03/14/2020
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