1619586682 NPI number — SAUNDRANITA REZIA POWE 1744P3200X

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619586682 NPI number — SAUNDRANITA REZIA POWE 1744P3200X

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWE
Provider First Name:
SAUNDRANITA
Provider Middle Name:
REZIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
1744P3200X
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POWE
Provider Other First Name:
SAUNDRANITA
Provider Other Middle Name:
REZIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED HAIRLOSS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619586682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17535 CORAL GABLES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHRUP VILLAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-259-2757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5642 W MAPLE RD STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-259-2757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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