Wilderness Shores Supplies, LLC

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

Legal business name

WILDERNESS SHORES SUPPLIES, LLC

Practice address

25614 Lake Wilderness LN SE
Maple Valley, WA 98038-6019

Phone

(206) 931-5284

Fax

(425) 413-5116

NPI assigned

Apr 2, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shirley Ann McMonagle

Title

Owner

Phone

(206) 931-5284

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270166400000",
    "number": "1144545054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25614 LAKE WILDERNESS LN SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386019",
            "telephone_number": "206-931-5284",
            "fax_number": "425-413-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25614 LAKE WILDERNESS LN SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386019",
            "telephone_number": "206-931-5284",
            "fax_number": "425-413-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS SHORES SUPPLIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-02",
        "last_updated": "2010-04-02",
        "status": "A",
        "authorized_official_last_name": "MCMONAGLE",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-931-5284",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmine Faye Whitaker
• Douglas Farrelly Whitfield, DDS
• Grace Raechel Whorley, LMHC
• Daron Wicker, MA, LMHCA
• Wilderness Shores Nursing, LLC
• Kristin Marie Wilkins, DPT
• Ethan Wilson, LMP
• Within Pelvic Health PT, PLLC
• Brianna Llyn Wood, M.A.
• Deborah Ann Wood

• Parenteral & Enteral Nutrition Supplies (DME) in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.