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General NPI Number Information
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NPI Number | 1942937958
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Entity Type | Organization
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Legal Business Name | QUEEN OF HEARTS COSMETICS
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 4019 RHYNE CIR SE
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City | SMYRNA
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State | GA
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Zip | 30082-4248
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Country | US
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Telephone | 201-936-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 RHYNE CIR SE
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City | SMYRNA
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State | GA
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Zip | 30082-4248
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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 | CRANIAL PROSTHESIS SPECIALIST
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Name | CHARESE NICOLE MAINOR
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Credential |
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Telephone | 201-936-0966
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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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