| NPI | 1013472174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANYA H WIEDENHOFF Owner 563-559-2767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 224900000X Mastectomy Fitter |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2020-02-26 |