Provider Demographics
NPI:1619357605
Name:CERTIFIED WOUND CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:CERTIFIED WOUND CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABIAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-262-3464
Mailing Address - Street 1:1356 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1798
Mailing Address - Country:US
Mailing Address - Phone:610-262-3464
Mailing Address - Fax:610-262-1404
Practice Address - Street 1:1356 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1798
Practice Address - Country:US
Practice Address - Phone:610-262-3464
Practice Address - Fax:610-262-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013454363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty