MEDICARE: INTEGRITY MEDICAL AND WOUNDS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	246XC2903X	Vascular Specialist/Technologist Cardiovascular
3	363LP2300X	Primary Care Nurse Practitioner
4	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1518653450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY MEDICAL AND WOUNDS LLC

Provider Business Mailing Address
First Line	:	801 S RANCHO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3860
Country	:	US
Telephone Number	:	702-331-4808
Fax Number	:	702-331-2035

Provider Business Practice Location Address
First Line	:	801 S RANCHO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3860
Country	:	US
Telephone Number	:	702-331-4808
Fax Number	:	702-331-2035

Authorized Official
Title or Position	:	MANAGER
Name	:	JACQUELINE WALKER
Credential	:	NP
Telephone Number	:	702-580-7997

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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