Healthcare Provider Details

I. General information

NPI: 1568005197
Provider Name (Legal Business Name): WOUND CARE CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LINDSEY ST
NEWPORT KY
41071-1537
US

IV. Provider business mailing address

410 LINDSEY ST
NEWPORT KY
41071-1537
US

V. Phone/Fax

Practice location:
  • Phone: 859-750-4786
  • Fax:
Mailing address:
  • Phone: 859-750-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ELAINE SHIELDS
Title or Position: OWNER/APRN
Credential:
Phone: 859-750-4786