Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Skinlab 360 Dermatology & Aesthetics LLC

Organization Physician Assistant · NPI 1376125740

Skinlab 360 Dermatology & Aesthetics LLC is a Physician Assistant in Rexburg, Idaho. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

117 W Main St Ste 101
Rexburg, ID 83440-1826
Phone: (208) 709-0478
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1376125740
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Julie Anderson — Owner · (208) 709-0478
NPI enumeratedApril 26, 2021
Last updated in NPPESApril 26, 2021
Certification dateApril 26, 2021
Mailing addressPo Box 3625, Idaho Falls, ID 83403-3625

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