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General NPI Number Information
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NPI Number | 1952124984
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Entity Type | Organization
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Legal Business Name | MARINES MOBILE WOUND CARE LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 15014 W WINDSOR AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-8955
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Country | US
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Telephone | 480-953-1143
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Fax |
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Provider Business Mailing Address
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Address Line | 15014 W WINDSOR AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-8955
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Country | US
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Telephone | 480-953-1143
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | ERIC MOSOKOBE OGARI
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Credential | NP
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Telephone | 480-953-1143
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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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