Healthcare Provider Details

I. General information

NPI: 1972344554
Provider Name (Legal Business Name): MOBILE WOUNDCURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 08/28/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

IV. Provider business mailing address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

V. Phone/Fax

Practice location:
  • Phone: 602-342-8418
  • Fax: 602-342-8328
Mailing address:
  • Phone: 602-342-8418
  • Fax: 602-342-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ALICIA KOHLS
Title or Position: OWNER
Credential: FNP
Phone: 715-205-0939