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General NPI Number Information
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NPI Number | 1164210134
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Entity Type | Organization
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Legal Business Name | MICHELLE HECK BEAUTY INK LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 664 GRAND AVE
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City | HARTFORD
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State | WI
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Zip | 53027-2208
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Country | US
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Telephone | 920-210-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 664 GRAND AVE
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City | HARTFORD
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State | WI
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Zip | 53027-2208
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Country | US
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Telephone | 920-210-6450
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Fax |
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Authorized Official
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Title or Position | OWNER/PARAMEDICAL TATTOOIST
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Name | MICHELLE A HECK
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Credential |
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Telephone | 920-210-6450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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