Provider Demographics
NPI:1093419350
Name:NISHONS BEAUTY
Entity Type:Organization
Organization Name:NISHONS BEAUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHETIC CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICHON
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-875-1073
Mailing Address - Street 1:6660 RIDGEFIELD CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3047
Mailing Address - Country:US
Mailing Address - Phone:248-875-1073
Mailing Address - Fax:
Practice Address - Street 1:26063 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1701
Practice Address - Country:US
Practice Address - Phone:833-333-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier