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General NPI Number Information
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NPI Number | 1770038937
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Entity Type | Organization
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Legal Business Name | HAIR REPLACEMENT CLINIC
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 1815 S WINDSOR
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City | WICHITA
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State | KS
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Zip | 67218
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Country | US
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Telephone | 316-390-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 S WINDSOR
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City | WICHITA
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State | KS
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Zip | 67218
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Country | US
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Telephone | 316-390-1280
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Fax |
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Authorized Official
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Title or Position | SPECIALIST/OWNER
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Name | DERITA JOH'NAY STRONG
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Credential | HAIR REPLACEMENT
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Telephone | 316-390-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 29647
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License Number State | KS
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