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General NPI Number Information
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NPI Number | 1013259753
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Entity Type | Organization
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Legal Business Name | HEARTQUEST SALON & WIG STUDIO LTD CO.
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1216 W WILLOW RD SUITE A
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City | ENID
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State | OK
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Zip | 73703-2532
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Country | US
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Telephone | 580-233-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 W WILLOW RD SUITE A
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City | ENID
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State | OK
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Zip | 73703-2532
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Country | US
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Telephone | 580-233-8333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PATRICIA LYNNE WEGENER
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Credential |
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Telephone | 580-233-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 59064-003
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License Number State | OK
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