Healthcare Provider Details

I. General information

NPI: 1235958950
Provider Name (Legal Business Name): I HEAL WOUNDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20307 GRAZING WAY
MONTGOMERY VILLAGE MD
20886-1211
US

IV. Provider business mailing address

509 QUINCE ORCHARD RD # 112
GAITHERSBURG MD
20878-1435
US

V. Phone/Fax

Practice location:
  • Phone: 240-521-6092
  • Fax:
Mailing address:
  • Phone: 240-521-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE MANNING BASS II
Title or Position: OWNER
Credential:
Phone: 240-521-6092