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General NPI Number Information
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NPI Number | 1699557496
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Entity Type | Organization
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Legal Business Name | WAVE HAIR COLLECTION LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 14417 SUNDIAL PL
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5896
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Country | US
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Telephone | 941-216-5184
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Fax |
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Provider Business Mailing Address
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Address Line | 14621 STATE ROAD 70 E # 235
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-8403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERRI LILLESTOL
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Credential |
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Telephone | 941-216-5184
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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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