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General NPI Number Information
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NPI Number | 1205523297
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Entity Type | Organization
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Legal Business Name | CLB TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 807 E JUNEAU AVE APT 7
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City | MILWAUKEE
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State | WI
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Zip | 53202-2751
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Country | US
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Telephone | 414-998-8420
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 N 18TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53206-2049
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Country | US
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Telephone | 414-998-8420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CANDIE L STATEN
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Credential |
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Telephone | 414-517-9351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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