Provider Demographics
NPI:1659374916
Name:MARVELLES APPAREL INC
Entity Type:Organization
Organization Name:MARVELLES APPAREL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARVELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEISPFENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:320-762-2439
Mailing Address - Street 1:1804 S. BRDWY, STE 160
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-762-2439
Mailing Address - Fax:320-762-2622
Practice Address - Street 1:1804 S. BROADWAY, STE #160
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-762-2439
Practice Address - Fax:320-762-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5224710001Medicare NSC