Organization
STACEY'S BRA AND LINGERIE SHOP, INC
Active
Other names
Stacey's Mastectomy Center
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY ANN BURNS-FOX CFM (PRESIDENT)
(515) 270-1399
Entity
Organization
Contact information
Practice address
10453 HICKMAN ROAD, URBANDALE, IA 50322-5032
(515) 226-9336
Mailing address
10453 HICKMAN ROAD, URBANDALE, IA 50322
(515) 270-1399
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102509
—
IA
Enumeration date
11/13/2006
Last updated
06/09/2022
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