Healthcare Provider Details

I. General information

NPI: 1124842588
Provider Name (Legal Business Name): PROFESSIONAL WOUND SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 16TH STREET STE 400 OFC 4080
DENVER CO
80202-5995
US

IV. Provider business mailing address

1400 16TH STREET STE 400 OFC 4080
DENVER CO
80202-5995
US

V. Phone/Fax

Practice location:
  • Phone: 888-434-8880
  • Fax: 855-434-8880
Mailing address:
  • Phone: 888-434-8880
  • Fax: 855-434-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKKI NGUYEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 888-434-8880