Organization
PRIMA DONNA SALON
Active
Other names
Payne's Cosmetologic Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHAUNA YVETTE PAYNE (OWNER)
(618) 580-2584
Entity
Organization
Contact information
Practice address
333 LONGVIEW DR, BELLEVILLE, IL 62223-4101
(618) 580-2584
(618) 277-0639
Mailing address
333 LONGVIEW DR, BELLEVILLE, IL 62223-4101
(618) 580-2584
(618) 277-0639
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
011307091
IL
335E00000X
Prosthetic/Orthotic Supplier
011307091
IL
Other
Enumeration date
01/02/2017
Last updated
01/02/2017
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