Healthcare Provider Details

I. General information

NPI: 1033933494
Provider Name (Legal Business Name): PROFESSIONAL WOUND SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

V. Phone/Fax

Practice location:
  • Phone: 888-434-8880
  • Fax: 855-434-8880
Mailing address:
  • Phone: 888-434-8880
  • Fax: 855-434-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKKI NGUYEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 888-434-8880