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General NPI Number Information
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NPI Number | 1578834925
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Entity Type | Organization
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Legal Business Name | VOGA WIGS & HAIR ADDS, LLC
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 904 S MILITARY AVE SUITE A
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City | GREEN BAY
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State | WI
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Zip | 54304-2115
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Country | US
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Telephone | 920-884-8642
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Fax | 920-884-9447
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Provider Business Mailing Address
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Address Line | 904 S MILITARY AVE SUITE A
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City | GREEN BAY
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State | WI
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Zip | 54304-2115
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Country | US
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Telephone | 920-884-8642
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Fax | 920-884-9447
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH MARLIN ZIMMERMAN
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Credential |
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Telephone | 920-884-8642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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