Provider Demographics
NPI:1245683556
Name:CERTIFIED WOUND CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:CERTIFIED WOUND CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:719-442-1924
Mailing Address - Street 1:403 SADDLEMOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2116
Mailing Address - Country:US
Mailing Address - Phone:719-442-1924
Mailing Address - Fax:719-442-1924
Practice Address - Street 1:1322 N ACADEMY BLVD
Practice Address - Street 2:STE 204
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3317
Practice Address - Country:US
Practice Address - Phone:719-377-2590
Practice Address - Fax:719-442-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0005016-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS62320Medicare UPIN