Provider Demographics
NPI:1629527486
Name:NATURAL LOOK SALON AND WIGS LLC
Entity Type:Organization
Organization Name:NATURAL LOOK SALON AND WIGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HAIRSTYLIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-617-5218
Mailing Address - Street 1:426 EASTERN TRAIL
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149
Mailing Address - Country:US
Mailing Address - Phone:262-617-5218
Mailing Address - Fax:
Practice Address - Street 1:4805 S. MOORLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:262-617-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42649-80332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies