Provider Demographics
NPI:1922341940
Name:HAIR INFINITI WELLNESS SALON LLC
Entity Type:Organization
Organization Name:HAIR INFINITI WELLNESS SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREANA
Authorized Official - Middle Name:RAMSEUR
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-726-5467
Mailing Address - Street 1:520 COLLINS AIKMAN DR
Mailing Address - Street 2:SUITE E205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3317
Mailing Address - Country:US
Mailing Address - Phone:704-726-5467
Mailing Address - Fax:
Practice Address - Street 1:520 COLLINS AIKMAN DR
Practice Address - Street 2:SUITE E205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3317
Practice Address - Country:US
Practice Address - Phone:704-726-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29628OtherHAIR LOSS SPECIALIST