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General NPI Number Information
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NPI Number | 1164978474
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Entity Type | Organization
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Legal Business Name | HAIR BY CHRISTINA ANN
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Dates
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Enumeration Date | 08/27/2016
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Last Update Date | 08/27/2016
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Provider Practice Location Address
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Address Line | 600 E CARMEL DR SUITE 214
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City | CARMEL
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State | IN
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Zip | 46032-2803
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Country | US
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Telephone | 317-702-7169
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E CARMEL DR SUITE 214
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City | CARMEL
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State | IN
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Zip | 46032-2803
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Country | US
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Telephone | 317-702-7169
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA ANN LOCKETT
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Credential |
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Telephone | 317-702-7169
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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 | BC20602823
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License Number State | IN
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