MEDICARE: INNOVATIVE WOUND SOLUTIONS, 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	163WW0000X	Wound Care Registered Nurse
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1649038910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE WOUND SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	10210 N 92ND ST STE 104
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4531
Country	:	US
Telephone Number	:	480-493-0900
Fax Number	:	833-228-0846

Provider Business Practice Location Address
First Line	:	10210 N 92ND ST STE 104
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4531
Country	:	US
Telephone Number	:	480-493-0900
Fax Number	:	833-228-0846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMY LORRAINE HUNN
Credential	:
Telephone Number	:	480-493-0900

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	12/31/2025

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