Provider Demographics
NPI:1073879599
Name:IT'S MAGIC MOMENTS LINGERIE
Entity Type:Organization
Organization Name:IT'S MAGIC MOMENTS LINGERIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSLAND
Authorized Official - Middle Name:RESHELL
Authorized Official - Last Name:DAWN-DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:469-685-5577
Mailing Address - Street 1:500 ROLLING HILLS PL
Mailing Address - Street 2:APT. 2006
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1027
Mailing Address - Country:US
Mailing Address - Phone:469-685-5577
Mailing Address - Fax:
Practice Address - Street 1:231 E BELT LINE RD
Practice Address - Street 2:BLDG. 2, SUITE 5
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5776
Practice Address - Country:US
Practice Address - Phone:469-685-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier