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General NPI Number Information
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NPI Number | 1275341042
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE LLC
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 100 PARK AVE STE 108A
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City | ROCKVILLE
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State | MD
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Zip | 20850-2651
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Country | US
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Telephone | 703-939-5763
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PARK AVE STE 108A
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City | ROCKVILLE
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State | MD
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Zip | 20850-2651
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Country | US
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Telephone | 703-939-5763
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TYLER STOUT
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Credential |
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Telephone | 337-315-7927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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