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General NPI Number Information
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NPI Number | 1043816077
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Entity Type | Organization
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Legal Business Name | HAIR BY KOLA LLC
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Dates
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Enumeration Date | 12/06/2020
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Last Update Date | 12/06/2020
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Provider Practice Location Address
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Address Line | 102 FLOWERS ST STE A
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City | KNIGHTDALE
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State | NC
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Zip | 27545-7832
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Country | US
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Telephone | 919-349-4231
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 SWEETGRASS ST
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City | KNIGHTDALE
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State | NC
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Zip | 27545-8161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KAYANA D HENNEGHAN
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Credential |
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Telephone | 919-349-4231
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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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