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General NPI Number Information
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NPI Number | 1568616225
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Entity Type | Organization
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Legal Business Name | NATURAL IMAGE BOUTIQUE
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 1414 W FAIR AVE SUITE 50 A
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-7978
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 W FAIR AVE SUITE 50 A
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-7978
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHARON L TABOR
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Credential | CFO
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Telephone | 906-225-7978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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