1316714413 NPI number — LASANDRA DENISE HATTON ALOPECIA WIG INSTALL

Table of content: LASANDRA DENISE HATTON ALOPECIA WIG INSTALL (NPI 1316714413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316714413 NPI number — LASANDRA DENISE HATTON ALOPECIA WIG INSTALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATTON
Provider First Name:
LASANDRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ALOPECIA WIG INSTALL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATTON
Provider Other First Name:
LASANDRA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HAIR DOCTOR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316714413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72214-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-612-7750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 JOHN BARROW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204-7364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-612-7750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2023

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: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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