Organization
MOMMY & ME BOUTIQUE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICHOLE LYNN DAVIS CLC (OWNER)
(217) 342-4774
Entity
Organization
Contact information
Practice address
314 W JEFFERSON AVE, EFFINGHAM, IL 62401-2352
(217) 342-4774
(217) 342-4776
Mailing address
314 W JEFFERSON AVE, EFFINGHAM, IL 62401-2352
(217) 342-4774
(217) 342-4776
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IL
Other
Enumeration date
04/17/2009
Last updated
01/27/2011
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