MEDICARE: GLAM OPULENCE SALON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1225994668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLAM OPULENCE SALON

Provider Business Mailing Address
First Line	:	5607 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-2631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5607 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-2631
Country	:	US
Telephone Number	:	318-290-8384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADAYSHA KEONDRIA TANNER
Credential	:
Telephone Number	:	318-290-8384

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “GLAM OPULENCE SALON ” Practice Location

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