Healthcare Provider Details

I. General information

NPI: 1023298429
Provider Name (Legal Business Name): TRUDY'S BOUTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 E EAST SOLON RD
RICHMOND IL
60071-9675
US

IV. Provider business mailing address

2919 E EAST SOLON RD
RICHMOND IL
60071-9675
US

V. Phone/Fax

Practice location:
  • Phone: 815-675-1128
  • Fax:
Mailing address:
  • Phone: 815-675-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRUDY EUNICE KRIEGER
Title or Position: PRESIDENT
Credential:
Phone: 815-675-2092