Organization
INNOVATIVE WOUND MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY CLYDE MANALILI (CFO)
(702) 703-1668
Entity
Organization
Contact information
Practice address
8551 W LAKE MEAD BLVD STE 200, LAS VEGAS, NV 89128-7642
(702) 703-1668
Mailing address
8551 W LAKE MEAD BLVD STE 200, LAS VEGAS, NV 89128-7642
(702) 726-9722
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
174400000X
Specialist
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
10/07/2024
Last updated
10/21/2025
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