Organization
MODERN MOMMY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TALISHA RENE HEIDEN (OWNER)
(480) 857-7187
Entity
Organization
Contact information
Practice address
3355 W CHANDLER BLVD STE 3, CHANDLER, AZ 85226-5096
(480) 857-7187
Mailing address
3355 W CHANDLER BLVD STE 3, CHANDLER, AZ 85226-5096
(480) 857-7187
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/10/2013
Last updated
09/10/2013
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