Organization
MOBILE WOUND CARE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER STOUT (MANAGER)
(337) 315-7927
Entity
Organization
Contact information
Practice address
111 E WISCONSIN AVE STE 1925, MILWAUKEE, WI 53202-4825
(414) 323-0260
Mailing address
111 E WISCONSIN AVE STE 1705, MILWAUKEE, WI 53202-4811
(414) 323-0260
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/16/2024
Last updated
12/27/2024
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