Provider Demographics
NPI:1952069601
Name:NATURAL U SALON LLC
Entity Type:Organization
Organization Name:NATURAL U SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CRANIAL PROTHESIS
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:SHAVONNE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-364-2869
Mailing Address - Street 1:5440 EXECUTIVE PL STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4145
Mailing Address - Country:US
Mailing Address - Phone:601-364-2869
Mailing Address - Fax:601-786-5858
Practice Address - Street 1:5440 EXECUTIVE PL STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4145
Practice Address - Country:US
Practice Address - Phone:601-364-2869
Practice Address - Fax:601-786-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier