Provider Demographics
NPI:1164178505
Name:MEJESTIC HAIR LUXURY WIGS & EXTENSIONS LLC
Entity Type:Organization
Organization Name:MEJESTIC HAIR LUXURY WIGS & EXTENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAKIMA
Authorized Official - Middle Name:VENISE
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-991-1109
Mailing Address - Street 1:70 S WINOOSKI AVE UNIT 298
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3898
Mailing Address - Country:US
Mailing Address - Phone:386-991-1109
Mailing Address - Fax:802-419-4847
Practice Address - Street 1:329 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5544
Practice Address - Country:US
Practice Address - Phone:386-991-1109
Practice Address - Fax:802-419-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier