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General NPI Number Information
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NPI Number | 1477238707
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Entity Type | Organization
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Legal Business Name | MAINY MANE HAIR BOUTIQUE
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 3003 EAST MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912
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Country | US
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Telephone | 248-234-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 21370 INDEPENDENCE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5545
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Country | US
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Telephone | 248-234-2393
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | CHARMAIN CARTER
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Credential |
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Telephone | 248-234-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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