Organization
VALLEY MOBILE WOUND CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADY EWING (OWNER)
(845) 543-5211
Entity
Organization
Contact information
Practice address
1288 DEVONSHIRE DR., PROVO, UT 84604
(801) 664-7688
Mailing address
1288 DEVONSHIRE DR., PROVO, UT 84604
(801) 664-7688
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LC1500X
Community Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
01/15/2025
Last updated
02/24/2025
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