MEDICARE: NANDEL ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063619708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANDEL ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	1635 COUNTY ROAD C W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1302
Country	:	US
Telephone Number	:	651-634-3668
Fax Number	:	651-634-9001

Provider Business Practice Location Address
First Line	:	1635 COUNTY ROAD C W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1302
Country	:	US
Telephone Number	:	651-634-3668
Fax Number	:	651-634-9001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DELWIN ALFRED WILSON
Credential	:	CERTIFIED PEDORTHIST
Telephone Number	:	651-634-3668

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	05/30/2008

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