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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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