Healthcare Provider Details

I. General information

NPI: 1013164706
Provider Name (Legal Business Name): ALETA'S BRAS & LINGERIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 E CENTRAL AVE SUITE A
WICHITA KS
67208-4245
US

IV. Provider business mailing address

5601 E CENTRAL AVE SUITE A
WICHITA KS
67208-4245
US

V. Phone/Fax

Practice location:
  • Phone: 316-682-0132
  • Fax: 316-612-6970
Mailing address:
  • Phone: 316-682-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateKS

VIII. Authorized Official

Name: ALETA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 316-682-0132