Healthcare Provider Details

I. General information

NPI: 1710815683
Provider Name (Legal Business Name): LUMENA WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 PRAIRIE CROSSING DR
MONTGOMERY IL
60538-4057
US

IV. Provider business mailing address

2436 PRAIRIE CROSSING DR
MONTGOMERY IL
60538-4057
US

V. Phone/Fax

Practice location:
  • Phone: 630-402-6627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YEWANDE BANIRE
Title or Position: CEO
Credential:
Phone: 630-402-6627