Provider Demographics
NPI:1326205972
Name:MOBILE WOUND CONSULTANTS INC
Entity Type:Organization
Organization Name:MOBILE WOUND CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRADY-ANSTOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:484-686-5409
Mailing Address - Street 1:1008 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1417
Mailing Address - Country:US
Mailing Address - Phone:484-686-5409
Mailing Address - Fax:
Practice Address - Street 1:1008 SECOND AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1417
Practice Address - Country:US
Practice Address - Phone:484-686-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty