Healthcare Provider Details

I. General information

NPI: 1700544186
Provider Name (Legal Business Name): WOWDAMNFOXY HAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/05/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 JONESTOWN RD # 74
HARRISBURG PA
17109-6214
US

IV. Provider business mailing address

4600 JONESTOWN RD # 74
HARRISBURG PA
17109-6214
US

V. Phone/Fax

Practice location:
  • Phone: 717-210-8970
  • Fax: 844-501-0120
Mailing address:
  • Phone: 717-210-8970
  • Fax: 844-501-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LATORIA BYAS
Title or Position: OWNER
Credential:
Phone: 717-210-8970