Healthcare Provider Details

I. General information

NPI: 1275807711
Provider Name (Legal Business Name): LWENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 N 55TH ST
MILWAUKEE WI
53210-1560
US

IV. Provider business mailing address

2815 N 55TH ST
MILWAUKEE WI
53210-1560
US

V. Phone/Fax

Practice location:
  • Phone: 414-324-9688
  • Fax: 414-988-5387
Mailing address:
  • Phone: 414-324-9688
  • Fax: 414-988-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. LEDELL WALTON
Title or Position: OWNER
Credential:
Phone: 414-324-9688