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General NPI Number Information
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NPI Number | 1831844661
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Entity Type | Organization
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Legal Business Name | AMOR WIGS AND EXTENSIONS
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 3419 VIRGINIA BEACH BLVD # 5462
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4419
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Country | US
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Telephone | 757-663-9610
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Fax | 757-250-9720
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Provider Business Mailing Address
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Address Line | 3419 VIRGINIA BEACH BLVD # 5462
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4419
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Country | US
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Telephone | 757-663-9610
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Fax | 757-250-9720
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOHNEA JARESE SHERROD
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Credential |
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Telephone | 757-663-9610
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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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