Deactivation Date: 3/31/2023
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical Art Specialist/Technologist |
246ZA2600X |
| NPI # | 1295191708 |
| LBN Legal business name | TWILIGHT TATTOO |
| Authorized official | TONI WALLIN - (MANAGER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 01/13/2016 |
| Last updated | 01/13/2016 - About 10 years ago |
| Identifiers | n/a |
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TWILIGHT TATTOO
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