Provider Demographics
NPI:1497436000
Name:WOUND REJUVENATION
Entity Type:Organization
Organization Name:WOUND REJUVENATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT- GERIATRIC NP
Authorized Official - Phone:724-984-7093
Mailing Address - Street 1:19022 APPLETREE HILL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5596
Mailing Address - Country:US
Mailing Address - Phone:724-984-7093
Mailing Address - Fax:
Practice Address - Street 1:19022 APPLETREE HILL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5596
Practice Address - Country:US
Practice Address - Phone:724-984-7093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty