Organization
MITZI NIKKOLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITZI MORRIS (OWNER)
(270) 627-1247
Entity
Organization
Contact information
Practice address
509 ELM ST, MARTIN, TN 38237-3407
(270) 627-1247
Mailing address
509 ELM ST, MARTIN, TN 38237-3407
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105006
COSMETOLOGY LICENSE
TN
Enumeration date
06/24/2020
Last updated
06/24/2020
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