Mommy & Me Boutique, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MOMMY & ME BOUTIQUE, INC.

Practice address

314 W Jefferson Ave
Effingham, IL 62401-2352

Phone

(217) 342-4774

Fax

(217) 342-4776

NPI assigned

Apr 17, 2009

Last updated

Jan 27, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nichole Lynn Davis, CLC

Title

Owner

Phone

(217) 342-4774

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1235372475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W JEFFERSON AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012352",
            "telephone_number": "217-342-4774",
            "fax_number": "217-342-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 W JEFFERSON AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012352",
            "telephone_number": "217-342-4774",
            "fax_number": "217-342-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMMY & ME BOUTIQUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-342-4774",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CLC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Effingham, IL
• Providers in Effingham, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.