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General NPI Number Information
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NPI Number | 1801567995
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Entity Type | Organization
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Legal Business Name | EXOTIC NOVA EXTENSIONS RX
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 9445 INDIANAPOLIS BLVD # 1212
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City | HIGHLAND
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State | IN
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Zip | 46322-2648
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Country | US
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Telephone | 219-617-3799
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Fax | 219-244-5596
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Provider Business Mailing Address
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Address Line | 8810 SUNFOREST LN
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City | PEARLAND
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State | TX
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Zip | 77584-2415
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Country | US
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Telephone | 219-617-3799
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Fax | 219-244-5596
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Authorized Official
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Title or Position | OWNER
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Name | BRITTANY A LEE
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Credential |
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Telephone | 219-617-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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