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General NPI Number Information
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NPI Number | 1245737048
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Entity Type | Organization
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Legal Business Name | WANNER ENTERPRISE
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 307 N TIMBERLAND DR
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City | LUFKIN
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State | TX
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Zip | 75901
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Country | US
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Telephone | 936-639-1391
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Fax |
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Provider Business Mailing Address
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Address Line | 307 N TIMBERLAND DR
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City | LUFKIN
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State | TX
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Zip | 75901-4097
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBIN WANNER
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Credential |
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Telephone | 936-639-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number |
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License Number State |
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