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General NPI Number Information
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NPI Number | 1932047289
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Entity Type | Organization
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Legal Business Name | TEODOR 1 INCORPORATED DBA PERSONAL WOUND CARE SERVICES
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 8221 PROVIDENT STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19150
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Country | US
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Telephone | 267-338-6382
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Fax | 888-252-9279
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Provider Business Mailing Address
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Address Line | 8221 PROVIDENT STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19150
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Country | US
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Telephone | 267-338-6382
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Fax | 888-252-9279
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Authorized Official
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Title or Position | COO
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Name | NICOLE MICHELLE THEODORE
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Credential | REGISTERED NURSE
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Telephone | 267-338-6382
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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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