MEDICARE: LUISE FARMER CERTIFIED HAIR LOSS

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	1744P3200X	Prosthetics Case Management	1302000245	VA

General Provider Information

NPI Number	:	1518424571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISE FARMER CERTIFIED HAIR LOSS

Provider Business Mailing Address
First Line	:	PO BOX 7335
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-0335
Country	:	US
Telephone Number	:	804-304-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 N BOULEVARD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-4802
Country	:	US
Telephone Number	:	804-304-3034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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Directions to “ LUISE FARMER CERTIFIED HAIR LOSS” Practice Location

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