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General NPI Number Information
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NPI Number | 1790357465
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Entity Type | Organization
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Legal Business Name | NATURALS BREAST BOUTIQUE LLC
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 804 N COLLEGE AVE STE 100
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3599
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Country | US
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Telephone | 812-361-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 804 N COLLEGE AVE STE 100
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3599
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Country | US
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Telephone | 812-361-2641
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELENA KINDER
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Credential | CMF
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Telephone | 812-361-2641
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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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