Provider Demographics
NPI:1952992687
Name:NAGENNEH STYLES
Entity type:Organization
Organization Name:NAGENNEH STYLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-430-5897
Mailing Address - Street 1:7411 OLD WELL STREET
Mailing Address - Street 2:APT I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9705 NORTHEAST PKWY STE 113
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9703
Practice Address - Country:US
Practice Address - Phone:704-430-5897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier