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General NPI Number Information
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NPI Number | 1730067489
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Entity Type | Organization
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Legal Business Name | PHOENIX SKIN AND WOUND CARE
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 4634 E LAUREL CT
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City | GILBERT
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State | AZ
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Zip | 85234-7849
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Country | US
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Telephone | 602-814-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 MARION BENNET DR
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City | LAS VEGAS
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State | NV
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Zip | 89106-2462
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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
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Name | HELEN GRACE MERIDOR
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Credential |
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Telephone | 602-814-1554
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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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