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General NPI Number Information
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NPI Number | 1649421884
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Entity Type | Organization
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Legal Business Name | D.B.A MOM'S MASTECTOMY
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 415 N 66TH ST SUITE 8
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City | LINCOLN
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State | NE
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Zip | 68505-2431
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Country | US
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Telephone | 402-464-6001
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Fax | 402-464-6669
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Provider Business Mailing Address
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Address Line | 415 N 66TH ST. SUITE 8
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City | LINCOLN
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State | NE
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Zip | 68505
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Country | US
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Telephone | 402-464-6001
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Fax | 402-464-6669
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Authorized Official
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Title or Position | OWNER
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Name | MISS JENNIFER LYNN HAWKINS
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Credential |
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Telephone | 402-464-6001
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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 | NE
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