Provider Demographics
NPI:1023815180
Name:FRONT RANGE MOBILE WOUND CARE LLC
Entity type:Organization
Organization Name:FRONT RANGE MOBILE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:720-824-5373
Mailing Address - Street 1:713 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5926
Mailing Address - Country:US
Mailing Address - Phone:901-463-7553
Mailing Address - Fax:
Practice Address - Street 1:713 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5926
Practice Address - Country:US
Practice Address - Phone:720-824-5373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty