Healthcare Provider Details

I. General information

NPI: 1073990578
Provider Name (Legal Business Name): WOUND CARE NATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14833 SW 173RD TER
MIAMI FL
33187-6701
US

IV. Provider business mailing address

14833 SW 173RD TER
MIAMI FL
33187-6701
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-0212
  • Fax: 305-328-9659
Mailing address:
  • Phone: 305-389-0212
  • Fax: 305-328-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberARNP9252211
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9252211
License Number StateFL

VIII. Authorized Official

Name: MRS. MONICA R MULET-HAM
Title or Position: PRESIDENT
Credential: ARNP
Phone: 305-244-0423