Provider Demographics
NPI:1619838000
Name:PREMIER WOUND CARE PLLC
Entity type:Organization
Organization Name:PREMIER WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASOMANING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-869-6536
Mailing Address - Street 1:65 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3113
Mailing Address - Country:US
Mailing Address - Phone:860-869-6536
Mailing Address - Fax:
Practice Address - Street 1:2389 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4617
Practice Address - Country:US
Practice Address - Phone:860-869-6536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty