Provider Demographics
NPI:1497347983
Name:LOTT, YVONIA (HAIR LOSS PRAC)
Entity Type:Individual
Prefix:
First Name:YVONIA
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:HAIR LOSS PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-2502
Mailing Address - Country:US
Mailing Address - Phone:662-699-0256
Mailing Address - Fax:
Practice Address - Street 1:54 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-2502
Practice Address - Country:US
Practice Address - Phone:662-699-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS525349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist