Provider Demographics
NPI:1720676380
Name:WEBSTER, DEMISHA NICOLE (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:DEMISHA
Middle Name:NICOLE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2236
Mailing Address - Country:US
Mailing Address - Phone:502-356-7890
Mailing Address - Fax:
Practice Address - Street 1:801 W BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2236
Practice Address - Country:US
Practice Address - Phone:502-356-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist