MEDICARE: MR. WAYNE C. MCLEOD APRN-BC

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
1	163WW0000X	Wound Care Registered Nurse	AP2122	AZ
2	363LF0000X	Family Nurse Practitioner	AP2122	AZ

General Provider Information

NPI Number	:	1477551109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE C. MCLEOD APRN-BC

Provider Business Mailing Address
First Line	:	9384 E MYRA DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-2940
Country	:	US
Telephone Number	:	520-318-3004
Fax Number	:	520-318-3061

Provider Business Practice Location Address
First Line	:	1200 N EL DORADO PL STE I910
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4637
Country	:	US
Telephone Number	:	520-318-3004
Fax Number	:	520-318-3061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/26/2024

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