Second to Nature Mastectomy Boutique

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

600186564 Issued in NC

Legal business name

SECOND TO NATURE MASTECTOMY BOUTIQUE

Practice address

500 State St Unit a
Greensboro, NC 27405-5659

Phone

(336) 274-2003

Fax

(336) 274-2052

NPI assigned

Nov 14, 2007

Organization subpart

No

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

Authorized official

Name

Ramona Rae Hertzell, CFM

Title

Owner

Phone

(336) 274-2003

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306108800000",
    "number": "1316128747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7968",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274170968",
            "telephone_number": "336-274-2003",
            "fax_number": "336-274-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 STATE ST UNIT A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055659",
            "telephone_number": "336-274-2003",
            "fax_number": "336-274-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND TO NATURE MASTECTOMY BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2011-05-23",
        "status": "A",
        "authorized_official_last_name": "HERTZELL",
        "authorized_official_first_name": "RAMONA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-274-2003",
        "authorized_official_credential": "CFM"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NC",
            "license": "600186564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0360A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7702598",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.