Provider Demographics
NPI:1669044905
Name:THE MANNEQUIN QUEEN LLC
Entity Type:Organization
Organization Name:THE MANNEQUIN QUEEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEESHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-928-1248
Mailing Address - Street 1:3614 CHIOS ISLAND RD APT 203
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-8377
Mailing Address - Country:US
Mailing Address - Phone:813-928-1248
Mailing Address - Fax:813-999-4857
Practice Address - Street 1:3614 CHIOS ISLAND RD APT 203
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-8377
Practice Address - Country:US
Practice Address - Phone:813-928-1248
Practice Address - Fax:813-999-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier