Provider Demographics
NPI:1821892746
Name:ARISE WOUND INSTITUTE PLLC
Entity type:Organization
Organization Name:ARISE WOUND INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMOT-DESOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-381-5607
Mailing Address - Street 1:7447 EGAN DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3301
Mailing Address - Country:US
Mailing Address - Phone:763-381-5607
Mailing Address - Fax:952-213-4647
Practice Address - Street 1:7447 EGAN DR STE 207
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-3301
Practice Address - Country:US
Practice Address - Phone:763-381-5607
Practice Address - Fax:952-213-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty