NPI 1558760611

A Beautiful You Mastectomy Boutique

Organisation Prosthetic/Orthotic Supplier Caldwell, ID

Practice location

Address: 2006 Blaine St, Caldwell, ID 83605-4343
Phone: (208) 985-5404

Authorised official

Name: Leanne M Kovick
Title: Owner/Operator
Phone: (208) 985-5404

Registered specialties

Prosthetic/Orthotic Supplier Primary

Suppliers Taxonomy 335E00000X Licence CFM02746 (ID)

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Registry record

NPI: 1558760611
Entity type: Organization
NPI issued: 14 Aug 2014
Record last updated: 12 Nov 2014

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.