Provider Demographics
NPI:1730067489
Name:PHOENIX SKIN AND WOUND CARE
Entity type:Organization
Organization Name:PHOENIX SKIN AND WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-814-1554
Mailing Address - Street 1:1675 MARION BENNET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4634 E LAUREL CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7849
Practice Address - Country:US
Practice Address - Phone:602-814-1554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty