Healthcare Provider Details

I. General information

NPI: 1053276246
Provider Name (Legal Business Name): ADVANCED WOUND MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

IV. Provider business mailing address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-0624
  • Fax:
Mailing address:
  • Phone: 702-560-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA MICHELLE SIMMONS
Title or Position: OWNER
Credential:
Phone: 702-483-5555