Organization
RENEUVIA WOUND CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD WALLIS (OWNER)
(816) 347-8884
Entity
Organization
Contact information
Practice address
1501 WESTPORT RD STE 101, KANSAS CITY, MO 64111-4366
(816) 347-8884
Mailing address
205 SW CRAIGMONT DR, LEES SUMMIT, MO 64081-1706
(816) 347-8884
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
—
—
Other
Enumeration date
03/22/2022
Last updated
08/15/2023
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