Healthcare Provider Details

I. General information

NPI: 1801659388
Provider Name (Legal Business Name): HAIR AND INK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 DE ROSE CT
BEAR DE
19701-1679
US

IV. Provider business mailing address

306 DE ROSE CT
BEAR DE
19701-1679
US

V. Phone/Fax

Practice location:
  • Phone: 302-897-2595
  • Fax:
Mailing address:
  • Phone: 302-897-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PAULACHOK
Title or Position: OWNER
Credential:
Phone: 302-897-2595