Provider Demographics
NPI:1396388187
Name:SEVEN DEGREE NORTH HAIR
Entity Type:Organization
Organization Name:SEVEN DEGREE NORTH HAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-768-2149
Mailing Address - Street 1:700 LOMBARDY AVE APT 7402
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3367
Mailing Address - Country:US
Mailing Address - Phone:757-768-2149
Mailing Address - Fax:
Practice Address - Street 1:700 LOMBARDY AVE APT 7402
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3367
Practice Address - Country:US
Practice Address - Phone:757-768-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier