Provider Demographics
NPI:1013726058
Name:SIMPLY WOUNDS ADVANCED WOUND CARE
Entity type:Organization
Organization Name:SIMPLY WOUNDS ADVANCED WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:773-484-6042
Mailing Address - Street 1:9915 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2007
Mailing Address - Country:US
Mailing Address - Phone:773-484-6042
Mailing Address - Fax:534-429-4415
Practice Address - Street 1:9915 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2007
Practice Address - Country:US
Practice Address - Phone:773-484-6042
Practice Address - Fax:534-429-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty