Healthcare Provider Details

I. General information

NPI: 1932944964
Provider Name (Legal Business Name): SANA WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 W TOWNSHIP ST
FAYETTEVILLE AR
72703-2821
US

IV. Provider business mailing address

22 W COLT SQUARE DR
FAYETTEVILLE AR
72703-2813
US

V. Phone/Fax

Practice location:
  • Phone: 479-900-5692
  • Fax: 479-888-7700
Mailing address:
  • Phone: 479-480-6677
  • Fax: 479-888-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATINKA VAN DER MERWE
Title or Position: OWNER
Credential: DC
Phone: 479-480-6677