Provider Demographics
NPI:1831975101
Name:DYNAMIC WOUND & OSTOMY CARE CLINIC : A NURSING SPECIALTY SERVICE
Entity type:Organization
Organization Name:DYNAMIC WOUND & OSTOMY CARE CLINIC : A NURSING SPECIALTY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:209-595-3514
Mailing Address - Street 1:1281 KEVIN WAY
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1318
Mailing Address - Country:US
Mailing Address - Phone:209-595-3514
Mailing Address - Fax:
Practice Address - Street 1:1281 KEVIN WAY
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1318
Practice Address - Country:US
Practice Address - Phone:209-595-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Multi-Specialty