Organization
NATURAL IMAGE BOUTIQUE
Active
Organization
NATURAL IMAGE BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON L TABOR CFO (OWNER)
(906) 225-7978
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 50 A, MARQUETTE, MI 49855-2675
(906) 225-7978
Mailing address
1414 W FAIR AVE, SUITE 50 A, MARQUETTE, MI 49855-2675
(906) 225-7978
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540E210750
BLUE CROSS BLUE SHIELD
MI
Enumeration date
11/07/2008
Last updated
11/07/2008
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