Healthcare Provider Details

I. General information

NPI: 1437093549
Provider Name (Legal Business Name): BRAIDING BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 W LEWIS ST STE 103
PASCO WA
99301-5874
US

IV. Provider business mailing address

1828 W LEWIS ST STE 103
PASCO WA
99301-5874
US

V. Phone/Fax

Practice location:
  • Phone: 509-619-2704
  • Fax:
Mailing address:
  • Phone: 509-619-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LATIFAH LYNEY
Title or Position: OWNER
Credential:
Phone: 509-619-2704