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NPI Code Detail

MEDICARE: ADVANCED WOUND MANAGEMENT LLC

MEDICARE: ADVANCED WOUND MANAGEMENT LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1053276246
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED WOUND MANAGEMENT LLC
Provider Business Mailing Address
First Line : 732 S 6TH ST STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-6928
Country : US
Telephone Number : 702-560-0624
Fax Number :
Provider Business Practice Location Address
First Line : 732 S 6TH ST STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-6928
Country : US
Telephone Number : 702-560-0624
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BRENDA MICHELLE SIMMONS
Credential :
Telephone Number : 702-483-5555
Provider Enumeration Date : 12/19/2025
Last Update Date : 12/19/2025

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Directions to “ADVANCED WOUND MANAGEMENT LLC ” Practice Location

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