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General NPI Number Information
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NPI Number | 1134184559
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Entity Type | Organization
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Legal Business Name | ALPHA WOUND CARE,LLC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 3363 SPYGLASS RDG
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City | HAMILTON
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State | OH
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Zip | 45013-8404
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Country | US
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Telephone | 513-623-0305
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Fax | 513-738-3038
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Provider Business Mailing Address
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Address Line | PO BOX 485
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City | ROSS
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State | OH
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Zip | 45061-0485
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Country | US
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Telephone | 513-623-0305
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Fax | 513-738-3038
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | SUSAN KENNERLY
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Credential | PHD,RN
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Telephone | 513-623-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State | OH
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