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General NPI Number Information
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NPI Number | 1730543950
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Entity Type | Organization
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Legal Business Name | LATESHA POWELL
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 8708 SHANNAN DR
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City | CLINTON
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State | MD
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Zip | 20735-2447
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Country | US
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Telephone | 301-404-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 8708 SHANNAN DR
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City | CLINTON
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State | MD
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Zip | 20735
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Country | US
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Telephone | 301-404-7312
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Fax |
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Authorized Official
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Title or Position | HAIRSTYLIST
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Name | MISS LATESHA T POWELL
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Credential |
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Telephone | 301-404-7312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 411602
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License Number State | MD
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