Provider Demographics
NPI:1235489840
Name:A WOMANS IMAGE LLC
Entity Type:Organization
Organization Name:A WOMANS IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PRZEKLAS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:586-286-1277
Mailing Address - Street 1:28966 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0942
Mailing Address - Country:US
Mailing Address - Phone:586-286-1277
Mailing Address - Fax:586-286-1702
Practice Address - Street 1:28966 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0942
Practice Address - Country:US
Practice Address - Phone:586-286-1277
Practice Address - Fax:586-286-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier