Provider Demographics
NPI:1073384673
Name:DERMAL WOUND WIZARDS LLC
Entity type:Organization
Organization Name:DERMAL WOUND WIZARDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAHL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-712-6950
Mailing Address - Street 1:26900 N LAKE PLEASANT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1558
Mailing Address - Country:US
Mailing Address - Phone:623-265-6271
Mailing Address - Fax:623-254-7100
Practice Address - Street 1:26900 N LAKE PLEASANT PARKWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383
Practice Address - Country:US
Practice Address - Phone:480-712-6950
Practice Address - Fax:623-254-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty