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General NPI Number Information
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NPI Number | 1447586466
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Entity Type | Organization
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Legal Business Name | WNG LLC
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 7667 W BEAVER ST LOT 5
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City | JACKSONVILLE
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State | FL
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Zip | 32220-3601
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Country | US
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Telephone | 904-553-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 7667 W BEAVER ST LOT 5
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City | JACKSONVILLE
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State | FL
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Zip | 32220-3601
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Country | US
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Telephone | 904-553-3744
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. DORIS GILLIAM
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Credential |
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Telephone | 904-553-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | FL
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