Organization
BRAVE ESSENTIALS LLC
Active
Other names
BRAVE Essentials
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE R FULKS (CEO)
(314) 922-3553
Entity
Organization
Contact information
Practice address
6018 DELMAR BLVD, SAINT LOUIS, MO 63112-1402
(314) 915-9740
Mailing address
3322 SAINT VINCENT AVE, SAINT LOUIS, MO 63104-1338
(314) 922-3553
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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