Provider Demographics
NPI:1235514209
Name:LIL BO PEEP 3D-4D ULTRASOUND AND BOUTIQUE
Entity type:Organization
Organization Name:LIL BO PEEP 3D-4D ULTRASOUND AND BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIAGNOSTIC SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:FRAZIER
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:910-690-6894
Mailing Address - Street 1:80 AVIEMORE CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9732
Mailing Address - Country:US
Mailing Address - Phone:910-690-6894
Mailing Address - Fax:
Practice Address - Street 1:80 AVIEMORE CT
Practice Address - Street 2:SUITE D
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9732
Practice Address - Country:US
Practice Address - Phone:910-690-6894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107830261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology