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General NPI Number Information
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NPI Number | 1780223750
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Entity Type | Individual
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Provider Name | ERIN CANNON COSMETOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 1543 N POST RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46219
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Country | US
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Telephone | 317-217-9939
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Fax |
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Provider Business Mailing Address
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Address Line | 1543 N POST RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46219
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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 |
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Name |
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Credential |
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Telephone |
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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 | BC21100489
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License Number State | IN
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