Organization
INDEPENDENT LIVING SUPPLIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROXANNE L PETERSON (MEMBER)
(414) 329-3962
Entity
Organization
Contact information
Practice address
6100 W BLUEMOUND RD, WAUWATOSA, WI 53213-4143
(414) 329-3962
(414) 329-3970
Mailing address
6100 W BLUEMOUND RD, WAUWATOSA, WI 53213-4143
(414) 329-3962
(414) 329-3970
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41733300
—
WI
Enumeration date
07/22/2005
Last updated
01/02/2008
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