Provider Demographics
NPI:1316714413
Name:HATTON, LASANDRA DENISE (ALOPECIA WIG INSTALL)
Entity type:Individual
Prefix:
First Name:LASANDRA
Middle Name:DENISE
Last Name:HATTON
Suffix:
Gender:F
Credentials:ALOPECIA WIG INSTALL
Other - Prefix:
Other - First Name:LASANDRA
Other - Middle Name:DENISE
Other - Last Name:HATTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR DOCTOR
Mailing Address - Street 1:PO BOX 4023
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72214-4023
Mailing Address - Country:US
Mailing Address - Phone:501-612-7750
Mailing Address - Fax:
Practice Address - Street 1:4120 JOHN BARROW RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7364
Practice Address - Country:US
Practice Address - Phone:501-612-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service