Provider Demographics
NPI:1568291011
Name:TWIN PEAKS WOUND AND WELLNESS CENTER
Entity type:Organization
Organization Name:TWIN PEAKS WOUND AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DORAN-SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-680-0018
Mailing Address - Street 1:700 TENACITY DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8487
Mailing Address - Country:US
Mailing Address - Phone:720-680-0018
Mailing Address - Fax:
Practice Address - Street 1:700 TENACITY DR UNIT 102
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8487
Practice Address - Country:US
Practice Address - Phone:720-680-0018
Practice Address - Fax:720-680-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty