Organization
WICKENBURG DIABETES & WOUND CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER STOUT (MANAGER)
(337) 315-7927
Entity
Organization
Contact information
Practice address
519 ROSE LN, WICKENBURG, AZ 85390-1448
(844) 888-0408
Mailing address
519 ROSE LN, WICKENBURG, AZ 85390-1448
(844) 888-0408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
03/05/2025
Last updated
11/06/2025
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