Provider Demographics
NPI:1831945237
Name:MADISON MOBILE WOUND CARE PRACTICE
Entity type:Organization
Organization Name:MADISON MOBILE WOUND CARE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE PRESCRIBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:608-577-2084
Mailing Address - Street 1:PO BOX 8334
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53708-8334
Mailing Address - Country:US
Mailing Address - Phone:608-577-2084
Mailing Address - Fax:
Practice Address - Street 1:401 NEW CASTLE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-6070
Practice Address - Country:US
Practice Address - Phone:608-577-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty