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General NPI Number Information
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NPI Number | 1417082728
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Entity Type | Organization
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Legal Business Name | HAIR RESPONSE
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2301 RIVERSIDE DR HAIR RESPONSE
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-619-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 RIVERSIDE DR HAIR RESPONSE
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-619-3662
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS VICKY ANN GARLAND
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Credential | CERTIFIED BREAST PRO
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Telephone | 920-437-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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