Organization
AGELESS BEAUTY MEDICAL SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN TRUDEAU (OWNER)
(774) 264-9600
Entity
Organization
Contact information
Practice address
2 CRANDALL RD STE B, TIVERTON, RI 02878-2646
(774) 264-9600
Mailing address
2 CRANDALL RD STE B, TIVERTON, RI 02878-2646
(774) 264-9600
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
01/21/2025
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