Healthcare Provider Details

I. General information

NPI: 1093891616
Provider Name (Legal Business Name): VIRGINIAS FEMININE BOUTIQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 152ND ST NE
MARYSVILLE WA
98271-8944
US

IV. Provider business mailing address

PO BOX 3768
ARLINGTON WA
98223-0800
US

V. Phone/Fax

Practice location:
  • Phone: 360-659-7928
  • Fax: 360-658-7178
Mailing address:
  • Phone: 360-659-7928
  • Fax: 360-658-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN SHIPP
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-659-7928