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General NPI Number Information
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NPI Number | 1073879599
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Entity Type | Organization
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Legal Business Name | IT'S MAGIC MOMENTS LINGERIE
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 231 E BELT LINE RD BLDG. 2, SUITE 5
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City | DESOTO
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State | TX
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Zip | 75115-5776
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Country | US
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Telephone | 469-685-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ROLLING HILLS PL APT. 2006
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City | LANCASTER
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State | TX
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Zip | 75146-1027
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Country | US
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Telephone | 469-685-5577
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPERATOR
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Name | MRS. ROSSLAND RESHELL DAWN-DARNELL
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Credential | LVN
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Telephone | 469-685-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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