Organization
SKINLAB 360 DERMATOLOGY & AESTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ANDERSON PA-C (OWNER)
(208) 709-0478
Entity
Organization
Contact information
Practice address
117 W MAIN ST STE 101, REXBURG, ID 83440-1826
(208) 709-0478
Mailing address
PO BOX 3625, IDAHO FALLS, ID 83403-3625
(800) 338-5378
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/26/2021
Last updated
04/26/2021
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