Organization
MADELINE ROSE MASTECTOMY BOUTIQUE, LLC
Active
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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