Healthcare Provider Details

I. General information

NPI: 1164974416
Provider Name (Legal Business Name): NU ELEGANCE HAIR SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E FRY BLVD
SIERRA VISTA AZ
85635-1825
US

IV. Provider business mailing address

640 E FRY BLVD
SIERRA VISTA AZ
85635-1825
US

V. Phone/Fax

Practice location:
  • Phone: 520-224-5054
  • Fax:
Mailing address:
  • Phone: 520-224-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number10901826
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number10901826
License Number StateAZ

VIII. Authorized Official

Name: TIFFANY HALL
Title or Position: CERTIFIED HAIR LOSS SPECIALIST
Credential: CERTIFIED HAIR LOSS
Phone: 520-216-0081