MEDICARE: VA ALLIANCE WOUND CARE SERVICES 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

General Provider Information

NPI Number	:	1093508798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA ALLIANCE WOUND CARE SERVICES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 8087
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-0118
Country	:	US
Telephone Number	:	888-706-1444
Fax Number	:	800-306-9538

Provider Business Practice Location Address
First Line	:	440 MONTICELLO AVE STE 1802
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	210-850-5790
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRENDA LEA BAKER
Credential	:	FNP-BC
Telephone Number	:	888-706-1444

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	01/28/2026

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