MEDICARE: ADVANCED WOUND MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1053276246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WOUND MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	702-560-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	702-560-0624
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRENDA MICHELLE SIMMONS
Credential	:
Telephone Number	:	702-483-5555

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ADVANCED WOUND MANAGEMENT LLC ” Practice Location

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