Provider Demographics
NPI:1871167502
Name:GODDESS ELECTROLYSIS LLC
Entity type:Organization
Organization Name:GODDESS ELECTROLYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ELECTROLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JULY
Authorized Official - Middle Name:
Authorized Official - Last Name:TWENTY-THREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-448-5742
Mailing Address - Street 1:2825 JOHNSON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3055
Mailing Address - Country:US
Mailing Address - Phone:651-399-2804
Mailing Address - Fax:
Practice Address - Street 1:2637 27TH AVE S STE 202
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3080
Practice Address - Country:US
Practice Address - Phone:612-448-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty