Provider Demographics
NPI:1831658301
Name:PRETTY MOMENTS LINGERIE, LLC
Entity Type:Organization
Organization Name:PRETTY MOMENTS LINGERIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-318-1811
Mailing Address - Street 1:63455 N HWY 97 SUITE 44
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703
Mailing Address - Country:US
Mailing Address - Phone:541-318-1811
Mailing Address - Fax:
Practice Address - Street 1:63455 N HWY 97 SUITE 44
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:541-318-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609353127OtherINDIVIDUAL NPI