Healthcare Provider Details

I. General information

NPI: 1841115144
Provider Name (Legal Business Name): HAIR TO STAY BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 3RD ST N
WAITE PARK MN
56387-1121
US

IV. Provider business mailing address

673 17TH ST S
SARTELL MN
56377-2166
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-3377
  • Fax:
Mailing address:
  • Phone: 320-291-0697
  • Fax:

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: MIRANDA GAJESKI
Title or Position: CEO
Credential:
Phone: 320-291-0697