Healthcare Provider Details

I. General information

NPI: 1518297308
Provider Name (Legal Business Name): WOUND CARE CENTER TR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST SUITE 201
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

PO BOX 33450
SEATTLE WA
98133-0450
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1244
  • Fax:
Mailing address:
  • Phone: 206-368-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WILLIAM SCHNEIDER
Title or Position: PRES/CEO
Credential:
Phone: 206-368-1700