Healthcare Provider Details

I. General information

NPI: 1003491184
Provider Name (Legal Business Name): CHAQUE FEMME BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201A CARTER ST
VIDALIA LA
71373-3303
US

IV. Provider business mailing address

PO BOX 151
VIDALIA LA
71373-0151
US

V. Phone/Fax

Practice location:
  • Phone: 318-650-8318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MISS JACINTA R WALKER
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-650-8318