MEDICARE: WOUNDWISE 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1932913944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUNDWISE LLC

Provider Business Mailing Address
First Line	:	1325 S 123RD DR
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-3140
Country	:	US
Telephone Number	:	480-851-0380
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S 123RD DR
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-3140
Country	:	US
Telephone Number	:	480-851-0380
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESS MARTIN SIOZON
Credential	:
Telephone Number	:	480-320-2725

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	07/23/2025

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