Healthcare Provider Details

I. General information

NPI: 1366920910
Provider Name (Legal Business Name): HALEYS DESIGNER WIGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 08/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6017 E MCKELLIPS RD STE 109
MESA AZ
85215-2824
US

IV. Provider business mailing address

6017 E MCKELLIPS RD STE 109
MESA AZ
85215-2824
US

V. Phone/Fax

Practice location:
  • Phone: 480-307-9466
  • Fax:
Mailing address:
  • Phone: 480-307-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HALEY MCKOY
Title or Position: OWNER
Credential:
Phone: 480-307-9466