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General NPI Number Information
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NPI Number | 1497135784
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Entity Type | Organization
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Legal Business Name | EYEBROW RENOVATION & PERMANENT MAKEUP
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 100 2ND ST NW
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5193
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Country | US
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Telephone | 434-825-0481
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Fax |
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Provider Business Mailing Address
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Address Line | 100 2ND ST NW
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5193
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Country | US
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Telephone | 434-825-0481
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY FRANCIS HUNTER
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Credential | CPCP
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Telephone | 434-825-0481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1236000418
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License Number State | VA
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