Organization
WATERLYN MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN MARIE MAURER (OFFICE MANAGER)
(704) 910-2146
Entity
Organization
Contact information
Practice address
12823 WATERLYN CLUB DR, CHARLOTTE, NC 28278-7680
(704) 910-2146
Mailing address
12823 WATERLYN CLUB DR, CHARLOTTE, NC 28278-7680
(704) 910-2146
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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