Provider Demographics
NPI:1689389090
Name:NIKKI SMITH HAIR COLLECTION
Entity Type:Organization
Organization Name:NIKKI SMITH HAIR COLLECTION
Other - Org Name:NIKKI SMITH HAIR COLLECTION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-904-1267
Mailing Address - Street 1:26140 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2454
Mailing Address - Country:US
Mailing Address - Phone:313-910-9355
Mailing Address - Fax:
Practice Address - Street 1:26140 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-2454
Practice Address - Country:US
Practice Address - Phone:313-910-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier