Provider Demographics
NPI:1598594483
Name:PROFESSIONAL WOUND SPECIALISTS PLLC
Entity type:Organization
Organization Name:PROFESSIONAL WOUND SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-434-8880
Mailing Address - Street 1:1845 W 4400 S STE A1
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3049
Mailing Address - Country:US
Mailing Address - Phone:888-434-8880
Mailing Address - Fax:855-434-8880
Practice Address - Street 1:1845 W 4400 S STE A1
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3049
Practice Address - Country:US
Practice Address - Phone:888-434-8880
Practice Address - Fax:855-434-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty