Healthcare Provider Details

I. General information

NPI: 1275002842
Provider Name (Legal Business Name): HAUTE HAIR WIGS AND EXTENSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 H ST NE STE A
WASHINGTON DC
20002-3662
US

IV. Provider business mailing address

820 H ST NE STE A
WASHINGTON DC
20002-3662
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-1090
  • Fax: 888-395-0772
Mailing address:
  • Phone: 202-543-1090
  • Fax: 888-395-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIA COLLEEN STEWART
Title or Position: OWNER
Credential:
Phone: 202-957-1331