Provider Demographics
NPI:1043739543
Name:IMPRESSIVE TRESSES SALON 3
Entity Type:Organization
Organization Name:IMPRESSIVE TRESSES SALON 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY-NEWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-432-8930
Mailing Address - Street 1:3059 N MAIN ST STE 20
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2799
Mailing Address - Country:US
Mailing Address - Phone:909-432-8930
Mailing Address - Fax:
Practice Address - Street 1:3059 N MAIN ST STE 20
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2799
Practice Address - Country:US
Practice Address - Phone:909-432-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS374481744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty