Provider Demographics
NPI:1912578493
Name:PYNK DYAMONDS BOUTIQUE LLC
Entity Type:Organization
Organization Name:PYNK DYAMONDS BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG-DESSASAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-588-5943
Mailing Address - Street 1:3548 THORNABY CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5600
Mailing Address - Country:US
Mailing Address - Phone:336-588-5943
Mailing Address - Fax:
Practice Address - Street 1:3548 THORNABY CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5600
Practice Address - Country:US
Practice Address - Phone:336-588-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty