| NPI | 1770916892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB NIELSEN Owner 262-955-8911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 456-1028557037-02) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: WI 456-1028557037-02) |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: WI 456-1028557037-02) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2013-08-13 |