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General NPI Number Information
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NPI Number | 1669044905
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Entity Type | Organization
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Legal Business Name | THE MANNEQUIN QUEEN LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 3614 CHIOS ISLAND RD APT 203
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City | SEFFNER
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State | FL
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Zip | 33584-8377
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Country | US
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Telephone | 813-928-1248
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Fax | 813-999-4857
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Provider Business Mailing Address
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Address Line | 3614 CHIOS ISLAND RD APT 203
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City | SEFFNER
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State | FL
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Zip | 33584-8377
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Country | US
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Telephone | 813-928-1248
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Fax | 813-999-4857
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Authorized Official
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Title or Position | OWNER
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Name | LAKEESHA S JAMES
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Credential |
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Telephone | 813-928-1248
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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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