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General NPI Number Information
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NPI Number | 1821892746
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Entity Type | Organization
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Legal Business Name | ARISE WOUND INSTITUTE PLLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 7447 EGAN DR STE 207
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City | SAVAGE
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State | MN
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Zip | 55378-3301
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Country | US
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Telephone | 763-381-5607
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Fax | 952-213-4647
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Provider Business Mailing Address
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Address Line | 7447 EGAN DR STE 207
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City | SAVAGE
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State | MN
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Zip | 55378-3301
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Country | US
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Telephone | 763-381-5607
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Fax | 952-213-4647
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Authorized Official
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Title or Position | OWNER
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Name | NANA WILMOT-DESOUZA
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Credential | MD
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Telephone | 763-381-5607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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