Healthcare Provider Details

I. General information

NPI: 1780419721
Provider Name (Legal Business Name): WOVEN CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/11/2025
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 355
CHICAGO IL
60611-2772
US

IV. Provider business mailing address

225 N ELIZABETH ST APT 2611
CHICAGO IL
60607-5241
US

V. Phone/Fax

Practice location:
  • Phone: 713-540-0010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NOLAN BROUSSARD
Title or Position: FOUNDER
Credential: MD
Phone: 713-540-0010