Provider Demographics
NPI:1053741603
Name:JENNINGS, NATALIE MICHELLE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MICHELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 HOPEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3180
Mailing Address - Country:US
Mailing Address - Phone:704-777-4279
Mailing Address - Fax:
Practice Address - Street 1:4952 HOPEWOOD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3180
Practice Address - Country:US
Practice Address - Phone:704-777-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC770331744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management