Provider Demographics
NPI:1801369004
Name:MERMAID PERMANENT COSMETICS LLC
Entity Type:Organization
Organization Name:MERMAID PERMANENT COSMETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPDA
Authorized Official - Phone:252-232-8035
Mailing Address - Street 1:380 CARATOKE HWY STE D
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8623
Mailing Address - Country:US
Mailing Address - Phone:252-232-8035
Mailing Address - Fax:
Practice Address - Street 1:380 CARATOKE HWY STE D
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8623
Practice Address - Country:US
Practice Address - Phone:252-232-8035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty