Provider Demographics
NPI:1396279915
Name:LADY MARIE HAIR RESTORATION
Entity type:Organization
Organization Name:LADY MARIE HAIR RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR REPLACEMENT SPECIALIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:810-625-5628
Mailing Address - Street 1:3506 BEECHER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4966
Mailing Address - Country:US
Mailing Address - Phone:810-625-5628
Mailing Address - Fax:
Practice Address - Street 1:3506 BEECHER RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4966
Practice Address - Country:US
Practice Address - Phone:810-625-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2702120165332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies