Destiny Med Spa PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

DESTINY MED SPA PLLC

Practice address

1415 W Dakota Pkwy Ste 3B
Williston, ND 58801-3885

Phone

(701) 354-9200

NPI assigned

Feb 27, 2019

Organization subpart

No

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

Authorized official

Name

Victoria Clair

Title

Director/Practice Manager

Phone

(701) 354-9200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1184181091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 W DAKOTA PKWY STE 3B",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013885",
            "telephone_number": "701-354-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W DAKOTA PKWY STE 3B",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013885",
            "telephone_number": "701-354-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY MED SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "CLAIR",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "DIRECTOR/PRACTICE MANAGER",
        "authorized_official_telephone_number": "701-354-9200"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Davis
• Maria Cristina Augusto De Souza, M.D.
• Laila Deleon-Casaerz
• Berenice Delgado
• Sarah Delorme
• Maddison Difonzo
• Cherilyn Victoria Dileo
• Erica Leigh Domonoske
• Misty Donnelly, PT
• Kindra Donvan, MS OTR/L

• Multi-Specialty Clinic/Center in Williston, ND
• Providers in Williston, ND by specialty
• Multi-Specialty Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.