Provider Demographics
NPI:1396612065
Name:IMAGINE U WOUND CARE LLC
Entity type:Organization
Organization Name:IMAGINE U WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KONNISHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-850-7241
Mailing Address - Street 1:6427 JESSE JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5704
Mailing Address - Country:US
Mailing Address - Phone:314-850-7241
Mailing Address - Fax:
Practice Address - Street 1:6427 JESSE JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5704
Practice Address - Country:US
Practice Address - Phone:314-850-7241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty