Healthcare Provider Details

I. General information

NPI: 1316714413
Provider Name (Legal Business Name): LASANDRA DENISE HATTON ALOPECIA WIG INSTALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LASANDRA DENISE HATTON HAIR DOCTOR

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 JOHN BARROW RD
LITTLE ROCK AR
72204-7364
US

IV. Provider business mailing address

PO BOX 4023
LITTLE ROCK AR
72214-4023
US

V. Phone/Fax

Practice location:
  • Phone: 501-612-7750
  • Fax:
Mailing address:
  • Phone: 501-612-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: