Organization
FABULOUS WEAVE , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANDREA DOCTOR RN (RNCONSULT FOR CRANIAL PROSTHESIS)
(301) 609-0845
Entity
Organization
Contact information
Practice address
10595 SOURWOOD AVE, WALDORF, MD 20603-5730
(301) 645-8765
(301) 645-9611
Mailing address
10595 SOURWOOD AVE, WALDORF, MD 20603-5730
(301) 645-8765
(301) 645-9611
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
07/30/2012
Last updated
07/30/2012
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