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General NPI Number Information
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NPI Number | 1578787313
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Entity Type | Organization
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Legal Business Name | DORIS' WIG BOUTIQUE
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8100 MARTY ST SUITE 104
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City | OVERLAND PARK
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State | KS
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Zip | 66204-3738
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Country | US
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Telephone | 913-649-0444
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Fax | 913-649-0130
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Provider Business Mailing Address
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Address Line | 8100 MARTY ST SUITE 104
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City | OVERLAND PARK
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State | KS
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Zip | 66204-3738
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Country | US
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Telephone | 913-649-0444
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Fax | 913-649-0130
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINDA ANN WHITE
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Credential |
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Telephone | 913-649-0444
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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 | 15848
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License Number State | KS
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