Provider Demographics
NPI:1578035713
Name:FEMININE FORMS LLC
Entity Type:Organization
Organization Name:FEMININE FORMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:801-380-8881
Mailing Address - Street 1:345 S 500 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2525
Mailing Address - Country:US
Mailing Address - Phone:801-380-8881
Mailing Address - Fax:
Practice Address - Street 1:345 S 500 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2525
Practice Address - Country:US
Practice Address - Phone:801-770-0600
Practice Address - Fax:801-770-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier