MEDICARE: WOUND CARE SPECIALISTS OF LAS CRUSES 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1437972106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE SPECIALISTS OF LAS CRUSES PLLC

Provider Business Mailing Address
First Line	:	1741 VISTA REAL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 VISTA REAL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3207
Country	:	US
Telephone Number	:	915-503-6535
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NIDIA KRAFT
Credential	:	FNP
Telephone Number	:	915-503-6535

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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