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General NPI Number Information
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NPI Number | 1164396602
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Entity Type | Organization
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Legal Business Name | WOUND RESOURCE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 7262 SUNNYSLOPE DR
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City | LANCASTER
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State | CA
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Zip | 93536-7363
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Country | US
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Telephone | 702-612-6316
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Fax |
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Provider Business Mailing Address
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Address Line | 8416 DELCO AVE
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City | WINNETKA
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State | CA
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Zip | 91306-1317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNA RUCKER
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Credential |
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Telephone | 702-612-6316
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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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