# LA IDEAL WOUND INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720964349
- **Authorized official:** TRACI PIERSANTI (OPERATIONS MANAGER)
- **Authorized official phone:** (877) 969-6863

## Contact information

- **Practice address:** 201 VICTORY BLVD, SUITE 287, MONROE, TX 71203
- **Practice address phone:** (877) 969-6863
- **Mailing address:** 1810 8TH AVE STE A101, FORT WORTH, TX 76110-1352
- **Mailing address phone:** (877) 969-6863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/12/2025
- **Last updated:** 08/12/2025