Wig Wam Boutique LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WIG WAM BOUTIQUE LLC

Practice address

313 W 17TH St
Bloomington, IN 47404-3453

Phone

(812) 332-4914

NPI assigned

Dec 15, 2017

Organization subpart

No

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

Authorized official

Name

Marshalene Evans

Title

Member & Registered Agent

Phone

(812) 498-1857

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513296000000",
    "number": "1821504697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 S GUM ST",
            "city": "NORTH VERNON",
            "state": "IN",
            "postal_code": "472652055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 W 17TH ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043453",
            "telephone_number": "812-332-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIG WAM BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-15",
        "last_updated": "2017-12-15",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MARSHALENE",
        "authorized_official_title_or_position": "MEMBER & REGISTERED AGENT",
        "authorized_official_telephone_number": "812-498-1857"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kegahn Whyte, RBT
• Hayley Rose Wible, D.O.
• Jonathan Wicks, ATC, LAT, M.ED
• Otto William Wickstrom III, M.D.
• Theresa Wiegand-Swihart, M.S.,OTR/CHT
• Lindsay Wiggs
• Marjorie Ellen Wiles, LCSW
• Lori Ann Wiley, P.T.
• Leslie A Wilfong, MSW, LCSW
• Jenna Wilkerson

• Durable Medical Equipment & Medical Supplies in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; 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.