Provider Demographics
NPI:1851189880
Name:YOUR NU IMAGE LLC
Entity type:Organization
Organization Name:YOUR NU IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEYSHA
Authorized Official - Middle Name:DEMAR
Authorized Official - Last Name:BOYD-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CHLP
Authorized Official - Phone:855-753-1919
Mailing Address - Street 1:5109 ROCK BEAUTY CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4789
Mailing Address - Country:US
Mailing Address - Phone:855-753-1919
Mailing Address - Fax:
Practice Address - Street 1:4475 REGENCY PL STE 301A
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3077
Practice Address - Country:US
Practice Address - Phone:855-753-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies