Provider Demographics
NPI:1275812885
Name:WOUND CARE CONSULTANTS OF CALIFORNIA NURSE PRACTITIONER, P.C.
Entity Type:Organization
Organization Name:WOUND CARE CONSULTANTS OF CALIFORNIA NURSE PRACTITIONER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:661-843-7841
Mailing Address - Street 1:7440 MEANY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5184
Mailing Address - Country:US
Mailing Address - Phone:661-843-7841
Mailing Address - Fax:661-864-7943
Practice Address - Street 1:7440 MEANY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5184
Practice Address - Country:US
Practice Address - Phone:661-843-7841
Practice Address - Fax:661-864-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17829163WW0000X
CA163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty