Provider Demographics
NPI:1063882116
Name:MOBILE WOUND CARE CONSULTANT LLC
Entity type:Organization
Organization Name:MOBILE WOUND CARE CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNAFE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATICADOS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, WCC
Authorized Official - Phone:630-544-8517
Mailing Address - Street 1:3241 JUSTAMERE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3759
Mailing Address - Country:US
Mailing Address - Phone:630-544-8517
Mailing Address - Fax:
Practice Address - Street 1:3241 JUSTAMERE RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3759
Practice Address - Country:US
Practice Address - Phone:630-544-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.280969163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty