Provider Demographics
NPI:1013289743
Name:NEW HAIR, LLC
Entity Type:Organization
Organization Name:NEW HAIR, LLC
Other - Org Name:NELL'S WIGS AND BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELLEN-KOLZE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:920-393-4912
Mailing Address - Street 1:1445 NORTH ROAD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5725
Mailing Address - Country:US
Mailing Address - Phone:920-393-4912
Mailing Address - Fax:
Practice Address - Street 1:1445 NORTH ROAD
Practice Address - Street 2:UNIT #1
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5725
Practice Address - Country:US
Practice Address - Phone:920-393-4912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier