Provider Demographics
NPI:1225912306
Name:BOSS LADY BY MIA
Entity type:Organization
Organization Name:BOSS LADY BY MIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:ARMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-589-5292
Mailing Address - Street 1:2710 PLEASANT AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1250
Mailing Address - Country:US
Mailing Address - Phone:757-589-5292
Mailing Address - Fax:
Practice Address - Street 1:2710 PLEASANT AVE APT 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1250
Practice Address - Country:US
Practice Address - Phone:757-589-5292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-02
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332H00000XSuppliersEyewear Supplier
No333600000XSuppliersPharmacy