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General NPI Number Information
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NPI Number | 1225920705
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Entity Type | Organization
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Legal Business Name | COVENANT WOUND CARE LLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2000 S THOMPSON ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-8759
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Country | US
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Telephone | 928-226-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 S J DIAMOND RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86005-9329
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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/PROVIDER
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Name | MICHAEL DALE HILBURN
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Credential | NP-C
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Telephone | 806-336-9061
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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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