Provider Demographics
NPI:1225354475
Name:INNOVATIONS WOUND MANAGEMENT, PA
Entity Type:Organization
Organization Name:INNOVATIONS WOUND MANAGEMENT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RRT, CHT
Authorized Official - Phone:713-301-5707
Mailing Address - Street 1:1234 WAGNER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3719
Mailing Address - Country:US
Mailing Address - Phone:713-301-5707
Mailing Address - Fax:713-295-2863
Practice Address - Street 1:1234 WAGNER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3719
Practice Address - Country:US
Practice Address - Phone:713-301-5707
Practice Address - Fax:713-295-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601127363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty