MEDICARE: GYZELE'S HAIR BOUTIQUE

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1316567795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GYZELE'S HAIR BOUTIQUE

Provider Business Mailing Address
First Line	:	1104 W SUNFLOWER RD
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2440
Country	:	US
Telephone Number	:	662-394-5084
Fax Number	:	662-262-5995

Provider Business Practice Location Address
First Line	:	1104 W SUNFLOWER RD
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2440
Country	:	US
Telephone Number	:	662-394-5084
Fax Number	:	662-262-5995

Authorized Official
Title or Position	:	OWNER
Name	:	GYZELE BROWN
Credential	:
Telephone Number	:	662-394-5084

Provider Enumeration Date	:	04/25/2020
Last Update Date	:	04/25/2020

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Directions to “GYZELE'S HAIR BOUTIQUE ” Practice Location

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