Organization
SECOND TO NATURE MASTECTOMY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMONA RAE HERTZELL CFM (OWNER)
(336) 274-2003
Entity
Organization
Contact information
Practice address
500 STATE ST UNIT A, GREENSBORO, NC 27405-5659
(336) 274-2003
(336) 274-2052
Mailing address
PO BOX 7968, GREENSBORO, NC 27417-0968
(336) 274-2003
(336) 274-2052
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
600186564
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0360A
BCBS
NC
05
—
7702598
—
NC
Enumeration date
11/14/2007
Last updated
05/23/2011
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