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General NPI Number Information
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NPI Number | 1649765736
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Entity Type | Organization
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Legal Business Name | NORDIC CARE, LLC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 1030 OAK RIDGE DR STE D
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6257
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Country | US
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Telephone | 715-598-8510
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Fax | 715-598-8511
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Provider Business Mailing Address
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Address Line | 1030 OAK RIDGE DR STE D
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6257
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Country | US
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Telephone | 715-598-8510
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Fax | 715-598-8511
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN KEITH WILSON
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Credential |
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Telephone | 715-559-5712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | WI
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