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Organization

WILDERNESS SHORES SUPPLIES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SHIRLEY ANN MCMONAGLE (OWNER)
(206) 931-5284
Entity
Organization

Contact information

Practice address
25614 LAKE WILDERNESS LN SE, MAPLE VALLEY, WA 98038-6019
(206) 931-5284
(425) 413-5116
Mailing address
25614 LAKE WILDERNESS LN SE, MAPLE VALLEY, WA 98038-6019
(206) 931-5284
(425) 413-5116

Taxonomy

Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
332BX2000X
Oxygen Equipment & Supplies (DME)

Other

Enumeration date
04/02/2010
Last updated
04/02/2010
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