Healthcare Provider Details

I. General information

NPI: 1730053547
Provider Name (Legal Business Name): MOBILE WOUND HEALING USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE R
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

13140 COUNTRY CLUB DR SW UNIT 204
LAKEWOOD WA
98498-5330
US

V. Phone/Fax

Practice location:
  • Phone: 800-968-4325
  • Fax: 888-309-6379
Mailing address:
  • Phone: 800-968-4325
  • Fax: 888-309-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LEIF ANDERSEN
Title or Position: OWNER
Credential:
Phone: 206-579-5574