Organization
A BEAUTIFUL YOU MASTECTOMY BOUTIQUE
Active
Organization
A BEAUTIFUL YOU MASTECTOMY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANNE KOVICK CFM (PRESIDENT)
(208) 985-5404
Entity
Organization
Contact information
Practice address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
(208) 402-5959
Mailing address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
(208) 402-5959
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CFM02746
ID
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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