Provider Demographics
NPI:1265737399
Name:WOUND TECHNOLOGY NETWORK
Entity type:Organization
Organization Name:WOUND TECHNOLOGY NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-417-6012
Mailing Address - Street 1:19736 SW 130TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4010
Mailing Address - Country:US
Mailing Address - Phone:786-417-6012
Mailing Address - Fax:
Practice Address - Street 1:19736 SW 130TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4010
Practice Address - Country:US
Practice Address - Phone:786-417-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
FLARNP9267311390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health