Organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Active
Parent organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUE, PLLC
Other names
Divine Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE DERMATOLOGY AND SURGICAL INSTITUE, PLLC
Authorized official
JENNIFER MICHELLE DIVINE (OWNER)
(970) 286-2668
Entity
Organization
Contact information
Practice address
1715 IRON HORSE DR STE 104, LONGMONT, CO 80501-9756
(970) 286-2668
(970) 294-4954
Mailing address
1260 DOCTORS LN STE A, FORT COLLINS, CO 80524-4072
(970) 286-2668
(970) 294-4954
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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