Healthcare Provider Details

I. General information

NPI: 1700169760
Provider Name (Legal Business Name): ARIZONA MOBILE WOUND CARE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 N 39TH DR
PHOENIX AZ
85029-3002
US

IV. Provider business mailing address

PO BOX 5520
GLENDALE AZ
85312-5520
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-7000
  • Fax: 602-588-3001
Mailing address:
  • Phone: 602-588-7000
  • Fax: 602-588-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. SOLANGE PIERRE-MICHEL
Title or Position: OWNER
Credential: FNP
Phone: 602-588-7000