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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CERT HAIRLOSS SPC

Contact information

Practice address
6491 WINCHESTER RD STE 143, MEMPHIS, TN 38115-4240
(800) 997-0599
Mailing address
6491 WINCHESTER RD STE 143, MEMPHIS, TN 38115-4240
(800) 997-0599

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
0000079069
TN
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
335E00000X
Prosthetic/Orthotic Supplier

Other

Enumeration date
04/12/2016
Last updated
01/11/2023
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