So Estheva Wellness Medspa LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

SO ESTHEVA WELLNESS MEDSPA LLC

Practice address

5730 Cleveland Rd
Wooster, OH 44691-1146

Phone

(330) 846-4100

NPI assigned

Feb 6, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Olivia Nicole Lust, PANPI 1811510761

Title

Co-Owner/Provider

Phone

(330) 635-2782

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Olivia Nicole Lust, PA-C

  • Physician Assistant
  • Wooster, OH
  • NPI 1811510761
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1124881693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 RUMBAUGH CIR",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446913009",
            "telephone_number": "306-352-7823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5730 CLEVELAND RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446911146",
            "telephone_number": "330-846-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SO ESTHEVA WELLNESS MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "LUST",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "CO-OWNER/PROVIDER",
        "authorized_official_telephone_number": "330-635-2782",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Smyers
• Melinda Snider, OTR
• Justin Snodgrass, NREMT
• Brenda Denise Snyder, LSW
• Cheryl Snyder, L.S.W.
• John Brent Sohar, LSW
• Amanda M Sojda, MSN, RN, IBCLC
• Caroline DH Sokol, M.D.
• Michael Sommers, LPCC-S, LSW
• Michelle Sommers, SLP

• Health Service Clinic/Center in Wooster, OH
• Providers in Wooster, OH by specialty
• Health Service Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.