Healthcare Provider Details

I. General information

NPI: 1013726058
Provider Name (Legal Business Name): SIMPLY WOUNDS ADVANCED WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11638 S PULASKI RD STE B
ALSIP IL
60803-1622
US

IV. Provider business mailing address

9915 W 143RD ST
ORLAND PARK IL
60462-2007
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-6042
  • Fax: 534-429-4415
Mailing address:
  • Phone: 773-484-6042
  • Fax: 534-429-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. IESHA NWAGWU
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 773-484-6042