Provider Demographics
NPI:1063619708
Name:NANDEL ENTERPRISES, INC.
Entity type:Organization
Organization Name:NANDEL ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELWIN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:651-634-3668
Mailing Address - Street 1:1635 COUNTY ROAD C W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1302
Mailing Address - Country:US
Mailing Address - Phone:651-634-3668
Mailing Address - Fax:651-634-9001
Practice Address - Street 1:1635 COUNTY ROAD C W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1302
Practice Address - Country:US
Practice Address - Phone:651-634-3668
Practice Address - Fax:651-634-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN82-766-7600Medicaid
MN82-766-7600Medicaid