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General NPI Number Information
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NPI Number | 1568665644
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Entity Type | Organization
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Legal Business Name | BRENDA STARR HAIRSTYLING
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 3105 WESTERN BRANCH BLVD SUITE #8
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5543
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Country | US
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Telephone | 757-638-7880
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Fax | 757-638-7880
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Provider Business Mailing Address
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Address Line | 3105 WESTERN BRANCH BLVD SUITE #8
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5543
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Country | US
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Telephone | 757-638-7880
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Fax | 757-638-7880
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA HARGROVE-ADDISON
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Credential |
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Telephone | 757-638-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1202017211
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License Number State | VA
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