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General NPI Number Information
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NPI Number | 1013669142
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Entity Type | Organization
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Legal Business Name | BUNNI MICHELLES SALON & BEAUTY BOUTIQUE LLC
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 3500 VIRGINIA BEACH BLVD STE 208
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 872-221-0616
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Fax | 888-474-7750
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Provider Business Mailing Address
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Address Line | 3500 VIRGINIA BEACH BLVD STE 208
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 872-221-0616
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Fax | 888-474-7750
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Authorized Official
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Title or Position | FOUNDER
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Name | EBONY MICHELLE JACKSON
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Credential |
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Telephone | 872-221-0616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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