Healthcare Provider Details

I. General information

NPI: 1124356993
Provider Name (Legal Business Name): NATURAL TRESSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2009
Last Update Date: 12/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 N RICHMOND ST
APPLETON WI
54911-2771
US

IV. Provider business mailing address

PO BOX 603
APPLETON WI
54912-0603
US

V. Phone/Fax

Practice location:
  • Phone: 920-268-5267
  • Fax: 920-358-5419
Mailing address:
  • Phone: 920-268-5267
  • Fax: 920-358-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MONTREAL C. GLOSSON
Title or Position: OWNER
Credential:
Phone: 920-257-6806