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General NPI Number Information
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NPI Number | 1619838000
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Entity Type | Organization
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Legal Business Name | PREMIER WOUND CARE PLLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2389 MAIN ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-4617
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Country | US
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Telephone | 860-869-6536
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Fax |
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Provider Business Mailing Address
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Address Line | 65 OAK ST
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3113
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Country | US
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Telephone | 860-869-6536
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SAMUEL ASOMANING
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Credential | APRN
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Telephone | 860-869-6536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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