Organization
BIRCH BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETA TOMANY RN,CMF (OWNER)
(715) 350-7174
Entity
Organization
Contact information
Practice address
612 CLEMONT ST, STE #8, ANTIGO, WI 54409-1988
(715) 350-7174
(715) 716-4330
Mailing address
612 CLEMONT ST, STE #8, ANTIGO, WI 54409-1988
(715) 350-7174
(715) 716-4330
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
09/27/2022
Last updated
02/29/2024
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