MEDICARE: HAIR VANITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1932958568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAIR VANITY LLC

Provider Business Mailing Address
First Line	:	26441 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-632-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	26441 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-632-2105
Fax Number	:

Authorized Official
Title or Position	:	HAIR LOSS SPT.
Name	:	CORLETHIA MARIE YARBROUGH
Credential	:
Telephone Number	:	248-632-2105

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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Directions to “HAIR VANITY LLC ” Practice Location

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