NPI 1083960801

Fabulous Weave , LLC

Organisation Customized Equipment (DME) Waldorf, MD

Practice location

Address: 10595 Sourwood Ave, Waldorf, MD 20603-5730
Phone: (301) 645-8765
Fax: (301) 645-9611

Authorised official

Name: Andrea Doctor
Title: Rnconsult for Cranial Prosthesis
Phone: (301) 609-0845

Registered specialties

Customized Equipment (DME) Primary

Suppliers Taxonomy 332BC3200X

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Registry record

NPI: 1083960801
Entity type: Organization
NPI issued: 30 Jul 2012
Record last updated: 30 Jul 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.