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General NPI Number Information
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NPI Number | 1912776998
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Entity Type | Organization
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Legal Business Name | SIMPLICITY WOUND CARE
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 790 N DIXIE AVE STE 801
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2473
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Country | US
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Telephone | 502-445-7957
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Fax |
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Provider Business Mailing Address
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Address Line | 790 N DIXIE AVE STE 801
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2473
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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 | CREDENTIALING MANAGER
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Name | JACQUELINE SANDERS
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Credential |
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Telephone | 502-630-2036
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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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