Organization
CINDERELLA WIGS & BREAST PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAJEAN JOHNSON ABC / BOC (OWNER)
(731) 623-4333
Entity
Organization
Contact information
Practice address
140 LAKE DR, TIPTONVILLE, TN 38079-1247
(731) 623-4333
(731) 623-4333
Mailing address
140 LAKE DR., TIPTONVILLE, TN 38079-1359
(731) 623-4333
(731) 623-4333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455190
TENN CARE MEDICAID
TN
01
—
4041082
BLUE CROSS BLUE SHIELD
TN
Enumeration date
11/26/2008
Last updated
11/04/2012
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