| Organization Name: | A WIG BOUTIQUE ETC. |
| NPI Number: | 1013248806 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELLE BLAKENEY (OWNER/OPERATOR) |
| Mailing Address: | 6707 Plantation Rd Suite C3 Pensacola |
| State: | FL US |
| Postal Code: | 325046214 |
| Phone Number: | 8504761916 |
| Fax Number: | 8504761916 |
| NPI Enumeration Date: | 01/19/2010 |
| NPI Last Update Date: | 01/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 660943 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |