Organization
ROSE BEAUTY BAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARKEISHA IAQUITA WARDELL (OWNER / STYLIST)
(931) 591-8501
Entity
Organization
Contact information
Practice address
1502 TINY TOWN RD, CLARKSVILLE, TN 37042-8087
(931) 645-4270
Mailing address
1502 TINY TOWN RD, CLARKSVILLE, TN 37042-8087
(931) 645-4270
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
08/21/2020
Last updated
08/21/2020
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