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General NPI Number Information
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NPI Number | 1124357553
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Entity Type | Organization
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Legal Business Name | DEL WILSON ENTERPRISES, INC.
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 14200 WAYZATA BLVD STE F
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City | MINNETONKA
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State | MN
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Zip | 55305-1746
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Country | US
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Telephone | 952-544-3668
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Fax | 952-544-0668
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Provider Business Mailing Address
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Address Line | 14200 WAYZATA BLVD STE F
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City | MINNETONKA
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State | MN
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Zip | 55305-1746
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Country | US
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Telephone | 952-544-3668
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Fax | 952-544-0668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DELWIN ALFRED WILSON
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Credential | CERTIFIED PEDORTHIST
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Telephone | 952-544-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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