Provider Demographics
NPI:1194161117
Name:PRECISION HAIR & WIG BOUTIQUE
Entity type:Organization
Organization Name:PRECISION HAIR & WIG BOUTIQUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MERCANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-369-3311
Mailing Address - Street 1:7 LIBERTY PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5539
Mailing Address - Country:US
Mailing Address - Phone:302-369-3311
Mailing Address - Fax:302-894-9358
Practice Address - Street 1:7 LIBERTY PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5539
Practice Address - Country:US
Practice Address - Phone:302-369-3311
Practice Address - Fax:302-894-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEM9 0000144335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier