Healthcare Provider Details

I. General information

NPI: 1295275295
Provider Name (Legal Business Name): FUSED HAIR STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 PARK RD A105
CHARLOTTE NC
28209-3700
US

IV. Provider business mailing address

4523 PARK RD A105
CHARLOTTE NC
28209
US

V. Phone/Fax

Practice location:
  • Phone: 704-522-3866
  • Fax:
Mailing address:
  • Phone: 704-522-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: TERESA NASH
Title or Position: BUSINESS OWNER
Credential:
Phone: 704-522-3866