Visage Integrative Medicine, LLC
Nurse Practitioner, Family in San Angelo, TX. Organization (NPI-2).
NPI number1497345003
StatusActive
Last updated in NPPESJan 19, 2021
Details
- NPI
- 1497345003
- Entity type
- Organization (NPI-2)
- Legal business name
- Visage Integrative Medicine, LLC
- Organization subpart
- No
- Enumeration date
- Jan 19, 2021
- Certification date
- Jan 19, 2021
- Last updated
- Jan 19, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Practice location
3144 Executive DrSan Angelo, TX 76904-6802
Phone 325-617-4594 · Fax 324-617-4593
Mailing address
3144 Executive DrSan Angelo, TX 76904-6802
Phone 325-617-4594 · Fax 324-617-4593
Authorized official
Susann Brundrett
Owner/Provider
3252342181
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