MEDICARE: QUALITY WOUND CARE PROVIDERS 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	363LA2100X	Acute Care Nurse Practitioner	631936	TX

General Provider Information

NPI Number	:	1417396730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY WOUND CARE PROVIDERS PLLC

Provider Business Mailing Address
First Line	:	25639 WEIGELA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2821
Country	:	US
Telephone Number	:	210-716-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	25639 WEIGELA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2821
Country	:	US
Telephone Number	:	210-716-7490
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	YVONNE MARIE ASHBAUGH
Credential	:	ACNP-BC,CWS, WON-AP
Telephone Number	:	210-716-7490

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	03/14/2014

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