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NPI Code Detail

MEDICARE: HALEYS DESIGNER WIGS

MEDICARE: HALEYS DESIGNER WIGS
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
1174400000XSpecialist

General Provider Information

NPI Number : 1366920910
Entity Type Code : Organization
Provider Name (Legal Business Name) : HALEYS DESIGNER WIGS
Provider Business Mailing Address
First Line : 6017 E MCKELLIPS RD STE 109
Second Line :
City : MESA
State : AZ
Zip : 85215-2824
Country : US
Telephone Number : 480-307-9466
Fax Number :
Provider Business Practice Location Address
First Line : 6017 E MCKELLIPS RD STE 109
Second Line :
City : MESA
State : AZ
Zip : 85215-2824
Country : US
Telephone Number : 480-307-9466
Fax Number :
Authorized Official
Title or Position : OWNER
Name : HALEY MCKOY
Credential :
Telephone Number : 480-307-9466
Provider Enumeration Date : 08/04/2018
Last Update Date : 08/04/2018

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Directions to “HALEYS DESIGNER WIGS ” Practice Location

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