MEDICARE: SIERRA WOUND CARE 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	363L00000X	Nurse Practitioner
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1699391003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA WOUND CARE LLC

Provider Business Mailing Address
First Line	:	2727 LBJ FWY STE 326
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 LBJ FWY STE 326
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7478
Country	:	US
Telephone Number	:	214-935-5791
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSELINE JONES
Credential	:	FNP
Telephone Number	:	214-935-5791

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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Directions to “SIERRA WOUND CARE LLC ” Practice Location

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