Organization
COEUR D'ALENE WIGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER LYNN LINDLEY (OWNER/PARTNER)
(208) 551-2761
Entity
Organization
Contact information
Practice address
296 W SUNSET AVE STE 17, COEUR D ALENE, ID 83815-8367
(208) 551-2761
Mailing address
PO BOX 1073, HAYDEN, ID 83835-1073
(208) 651-5109
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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