Provider Demographics
NPI:1508846643
Name:WOMEN MAKING A DIFFERENCE INC
Entity Type:Organization
Organization Name:WOMEN MAKING A DIFFERENCE INC
Other - Org Name:LINDAS SPECIALTY SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-6573
Mailing Address - Street 1:3411 N 5TH AVE
Mailing Address - Street 2:# 304
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:52013
Mailing Address - Country:US
Mailing Address - Phone:602-256-6573
Mailing Address - Fax:602-256-6653
Practice Address - Street 1:3411 N 5TH AVE
Practice Address - Street 2:# 304
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:52013
Practice Address - Country:US
Practice Address - Phone:602-256-6573
Practice Address - Fax:602-256-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07671843K332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4711440001Medicare ID - Type Unspecified