Healthcare Provider Details

I. General information

NPI: 1831985894
Provider Name (Legal Business Name): INNOVATIVE WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 06/10/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 PLAINFIELD NAPERVILLE RD STE 105
NAPERVILLE IL
60564-4239
US

IV. Provider business mailing address

4015 PLAINFIELD NAPERVILLE RD STE 105
NAPERVILLE IL
60564-4239
US

V. Phone/Fax

Practice location:
  • Phone: 630-912-8050
  • Fax:
Mailing address:
  • Phone: 630-912-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDNESHA RAMEY
Title or Position: PRESIDENT
Credential: NP
Phone: 930-912-8050