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General NPI Number Information
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NPI Number | 1548672017
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Entity Type | Organization
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Legal Business Name | HAIR IMAGE AND EXPRESSIONS
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1516 SAINT ANDREW ST
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City | TARBORO
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State | NC
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Zip | 27886-2534
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Country | US
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Telephone | 252-885-7695
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 SAINT ANDREW ST
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City | TARBORO
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State | NC
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Zip | 27886-2534
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Country | US
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Telephone | 252-885-7695
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Fax |
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Authorized Official
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Title or Position | COSMETOLOGIST/ HAIR REPLACEMET SPEC
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Name | MS. LORETTA RANA HILLIARD
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Credential | COS/ ESTHECTICIAN
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Telephone | 252-885-7695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | C68563
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License Number State | NC
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