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General NPI Number Information
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NPI Number | 1164211538
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Entity Type | Organization
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Legal Business Name | HIGH DESERT WOUND CARE
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 3856 N BONITA RD
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City | GOLDEN VALLEY
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State | AZ
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Zip | 86413-9353
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Country | US
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Telephone | 928-377-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 3856 N BONITA RD
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City | GOLDEN VALLEY
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State | AZ
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Zip | 86413-9353
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Country | US
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Telephone | 928-377-0355
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JUDITH MARY LASSEN
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Credential | DNP,FNP-BC
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Telephone | 928-377-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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