Organization
MADELINE ROSE MASTECTOMY BOUTIQUE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAMIE LEIGH WALCK CMF (OWNER)
(607) 296-2021
Entity
Organization
Contact information
Practice address
100 RANO BLVD, VESTAL, NY 13850-2776
(607) 296-2021
(607) 296-2023
Mailing address
100 RANO BLVD, VESTAL, NY 13850-2776
(607) 296-2021
(607) 296-2023
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
07/26/2022
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