=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710791751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUNDCARE CONNECT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 KAYEN KADADA
-----------------------------------------------------
City | DEDEDO
-----------------------------------------------------
State | GUAM (GU) UNITED STATES
-----------------------------------------------------
Zip | 96929
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 671-727-8811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 KAYEN KADADA
-----------------------------------------------------
City | DEDEDO
-----------------------------------------------------
State | GUAM (GU) UNITED STATES
-----------------------------------------------------
Zip | 96929
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MR. VICENTE IGNACIO UNT JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 671-687-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------