Organization
DLS MEDICAL EQUIPMENT PROVIDER
Active
Parent organization
OUR DESTINY, LLC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUR DESTINY, LLC.
Authorized official
KATINA FULLER (MEMBER)
(414) 349-1012
Entity
Organization
Contact information
Practice address
4115 N 56TH ST, SUITE B165, MILWAUKEE, WI 53216-1269
(414) 349-1012
Mailing address
4115 N 56TH ST, SUITE B165, MILWAUKEE, WI 53216-1269
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41567700
—
WI
Enumeration date
05/02/2008
Last updated
05/02/2008
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