MEDICARE: SIMPLY WOUNDS AND LYMPHATICS, PLLC

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	363L00000X	Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073464301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY WOUNDS AND LYMPHATICS, PLLC

Provider Business Mailing Address
First Line	:	9401 S PULASKI RD UNIT 3N
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-1924
Country	:	US
Telephone Number	:	773-416-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 S PULASKI RD UNIT 3N
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-1924
Country	:	US
Telephone Number	:	773-416-9936
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUMMER M JACKSON
Credential	:
Telephone Number	:	773-416-9936

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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