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General NPI Number Information
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NPI Number | 1164974416
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Entity Type | Organization
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Legal Business Name | NU ELEGANCE HAIR SOLUTIONS LLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 640 E FRY BLVD
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1825
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Country | US
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Telephone | 520-224-5054
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Fax |
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Provider Business Mailing Address
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Address Line | 640 E FRY BLVD
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1825
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Country | US
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Telephone | 520-224-5054
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | TIFFANY HALL
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Credential | CERTIFIED HAIR LOSS
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Telephone | 520-216-0081
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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 | 10901826
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 10901826
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License Number State | AZ
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