Organization
ELEGANT PROFILE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTINE JUCHTER (VICE PRESIDENT)
(336) 331-3480
Entity
Organization
Contact information
Practice address
4622 COUNTRY CLUB RD STE 100, WINSTON SALEM, NC 27104-3770
(336) 331-3480
(336) 793-1218
Mailing address
4622 COUNTRY CLUB RD STE 100, WINSTON SALEM, NC 27104-3770
(336) 331-3480
(336) 793-1218
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/17/2024
Last updated
04/21/2025
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