Provider Demographics
NPI:1528356425
Name:ZANDERS, KIMBERLY (LICENSED COSMETOLOGY)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ZANDERS
Suffix:
Gender:F
Credentials:LICENSED COSMETOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 GOODWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5222
Mailing Address - Country:US
Mailing Address - Phone:225-329-6699
Mailing Address - Fax:
Practice Address - Street 1:11015 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5222
Practice Address - Country:US
Practice Address - Phone:225-329-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA298836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA331125826OtherTAX IDENTIFICATION NUMBER