Provider Demographics
NPI:1154576494
Name:SUNRISE PRODUCTS OF WATERVILLE MINNESOTA INC
Entity type:Organization
Organization Name:SUNRISE PRODUCTS OF WATERVILLE MINNESOTA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:POEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-362-8015
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56096-0105
Mailing Address - Country:US
Mailing Address - Phone:507-362-8015
Mailing Address - Fax:507-362-4865
Practice Address - Street 1:215 HOOSAC ST W
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:MN
Practice Address - Zip Code:56096
Practice Address - Country:US
Practice Address - Phone:507-362-8015
Practice Address - Fax:507-362-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies