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General NPI Number Information
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NPI Number | 1629527486
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Entity Type | Organization
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Legal Business Name | NATURAL LOOK SALON AND WIGS LLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 4805 S. MOORLAND RD
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-617-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 426 EASTERN TRAIL
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City | MUKWONAGO
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State | WI
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Zip | 53149
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Country | US
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Telephone | 262-617-5218
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Fax |
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Authorized Official
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Title or Position | OWNER/HAIRSTYLIST
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Name | MRS. JULIE ANN MCCORMICK
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Credential |
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Telephone | 262-617-5218
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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 | 42649-80
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License Number State | WI
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