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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