Provider Demographics
NPI:1093891616
Name:VIRGINIAS FEMININE BOUTIQUE, LLC
Entity Type:Organization
Organization Name:VIRGINIAS FEMININE BOUTIQUE, LLC
Other - Org Name:VIRGINIA LEE SHIPP
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-659-7928
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-0800
Mailing Address - Country:US
Mailing Address - Phone:360-659-7928
Mailing Address - Fax:360-658-7178
Practice Address - Street 1:3627 152ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8944
Practice Address - Country:US
Practice Address - Phone:360-659-7928
Practice Address - Fax:360-658-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA130242OtherLABOR & INDUSTRIES
WA097172001OtherGROUP HEALTH
WA9062472Medicaid
WA130242OtherLABOR & INDUSTRIES