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General NPI Number Information
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NPI Number | 1558051391
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Entity Type | Organization
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Legal Business Name | QUEENS AND CROWNS HAIR BOUTIQUE LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 4597 SAINT ELMO AVE
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City | MEMPHIS
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State | TN
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Zip | 38128-2459
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Country | US
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Telephone | 901-446-8262
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Fax | 901-328-6370
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Provider Business Mailing Address
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Address Line | PO BOX 80735
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City | MEMPHIS
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State | TN
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Zip | 38108-0735
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Country | US
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Telephone | 901-446-8262
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Fax | 901-328-6370
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Authorized Official
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Title or Position | OWNER
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Name | TIJUANA STEWART
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Credential |
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Telephone | 901-446-8262
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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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