The Wig Gallery LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

THE WIG GALLERY LLC

Practice address

330 E 1St St Ste 3
Port Angeles, WA 98362-3133

Phone

(360) 477-4612

NPI assigned

Mar 28, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Ann Petrie

Title

Owner

Phone

(360) 477-4612

Specialties & licenses 1

Addresses

Tax ID family

The Wig Gallery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Wig Gallery LLC

  • Preferred Provider Organization
  • Portland, OR
  • NPI 1245806934
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1306697370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E 1ST ST STE 3",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623133",
            "telephone_number": "360-477-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E 1ST ST STE 3",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623133",
            "telephone_number": "360-477-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WIG GALLERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-03-28",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "PETRIE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-477-4612"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.