1730538992 NPI number — TOMEKA HATFIELD STEPHENS CERTIFIED HAIR LOSS

Table of content: TOMEKA HATFIELD STEPHENS CERTIFIED HAIR LOSS (NPI 1730538992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730538992 NPI number — TOMEKA HATFIELD STEPHENS CERTIFIED HAIR LOSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
TOMEKA
Provider Middle Name:
HATFIELD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED HAIR LOSS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATFIELD
Provider Other First Name:
TOMEKA
Provider Other Middle Name:
DEVONDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730538992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 W FRONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27215-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-675-6494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 W FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-675-6494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2016

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 , with the licence number:  1744P3200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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