Healthcare Provider Details

I. General information

NPI: 1922968478
Provider Name (Legal Business Name): WOUND RX MOBILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N CUMBERLAND AVE STE 10B SUITE 10B
NORRIDGE IL
60706-4277
US

IV. Provider business mailing address

4701 N CUMBERLAND AVE STE 10B
NORRIDGE IL
60706-4277
US

V. Phone/Fax

Practice location:
  • Phone: 630-670-8320
  • Fax: 708-452-7990
Mailing address:
  • Phone: 630-670-8320
  • Fax: 708-452-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA R JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 630-670-8320