Provider Demographics
NPI:1699890400
Name:WARE, SIRRON MARION (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:SIRRON
Middle Name:MARION
Last Name:WARE
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 BISHOPS PL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5501
Mailing Address - Country:US
Mailing Address - Phone:757-484-6389
Mailing Address - Fax:
Practice Address - Street 1:1128 BATTLEFIELD BLVD N STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4791
Practice Address - Country:US
Practice Address - Phone:757-549-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12011031991744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management