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General NPI Number Information
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NPI Number | 1396938346
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Entity Type | Organization
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Legal Business Name | WOUND CARE SPECIALISTS OF OHIO LLC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 670 WINDING WOODS DR
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City | LOVELAND
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State | OH
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Zip | 45140-9170
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Country | US
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Telephone | 513-478-5300
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Fax | 513-785-0667
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | LOVELAND
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State | OH
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Zip | 45140-0004
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Country | US
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Telephone | 513-478-5300
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Fax | 513-785-0667
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY LYNN PAYNE
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Credential | NP
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Telephone | 513-478-5300
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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 | NP-06865
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License Number State | OH
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