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General NPI Number Information
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NPI Number | 1912537705
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Entity Type | Organization
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Legal Business Name | THE W BEAUTY AND BARBER LOUNGE
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 18718 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48223-2215
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Country | US
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Telephone | 313-340-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 18718 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48223-2215
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Country | US
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Telephone | 313-340-2834
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Fax |
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Authorized Official
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Title or Position | LICENSED COSMETOLOGISTS
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Name | MRS. GABRIEL EPIPHANY WILSON
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Credential |
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Telephone | 313-213-7443
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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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