Organization
WOUND COMPANY PROVIDER GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANTLEY TILMAN JOLLY JR. MD (PRESIDENT)
(703) 447-6897
Entity
Organization
Contact information
Practice address
2240 DREW AVE S, MINNEAPOLIS, MN 55416-3646
(858) 774-6305
Mailing address
2240 DREW AVE S, MINNEAPOLIS, MN 55416-3646
(858) 774-6305
Taxonomy
Speciality
Code
Description
License number
State
163WC2100X
Continence Care Registered Nurse
—
—
163WE0900X
Enterostomal Therapy Registered Nurse
—
—
163WW0000X
Wound Care Registered Nurse
Primary
—
—
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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