Provider Demographics
NPI:1003027855
Name:DONNA'S LINGERIE & SWIMWEAR, INC.
Entity Type:Organization
Organization Name:DONNA'S LINGERIE & SWIMWEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:PESSON
Authorized Official - Last Name:MIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-477-1804
Mailing Address - Street 1:3518 RYAN STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6526
Mailing Address - Country:US
Mailing Address - Phone:337-477-1804
Mailing Address - Fax:337-477-5431
Practice Address - Street 1:3518 RYAN STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6526
Practice Address - Country:US
Practice Address - Phone:337-477-1804
Practice Address - Fax:337-477-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0700004274335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7211791790OtherTAX ID
LA0657590001Medicare ID - Type Unspecified