| Integrated Wound Care Management Wisconsin Llc | |
|
1800 New York Ave Superior WI 54880-2008 | |
| (201) 870-1194 | |
| Not Available |
| Full Name | Integrated Wound Care Management Wisconsin Llc |
|---|---|
| Speciality | General Practice |
| Location | 1800 New York Ave, Superior, Wisconsin |
| Authorized Official Name and Position | Diane Lusas (MEMBER) |
| Authorized Official Contact | 7324514318 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Wound Care Management Wisconsin Llc 492c Cedar Ln Ste 513 Teaneck NJ 07666-1713 Ph: () - | Integrated Wound Care Management Wisconsin Llc 1800 New York Ave Superior WI 54880-2008 Ph: (201) 870-1194 |
| NPI Number | 1154963049 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 10/11/2019 |
| Medicare PECOS PAC ID | 3375976038 |
|---|---|
| Medicare Enrollment ID | O20191210003327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154963049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Trudy A Mara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558326967 PECOS PAC ID: 6608898358 Enrollment ID: I20051222000373 |
| Provider Name | Tammy L Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528134129 PECOS PAC ID: 6901824333 Enrollment ID: I20190116003720 |
| Provider Name | Chelsea N Fay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699337824 PECOS PAC ID: 1759611486 Enrollment ID: I20190924000817 |
| Provider Name | Kara L Fausch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417124553 PECOS PAC ID: 6103965553 Enrollment ID: I20191216002361 |
| Provider Name | Alison Jayme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174965164 PECOS PAC ID: 5890928204 Enrollment ID: I20210128000775 |
| Provider Name | Elizabeth C Stevenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205436821 PECOS PAC ID: 4981003027 Enrollment ID: I20210524000506 |
| Provider Name | Tiffany J Radke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730588823 PECOS PAC ID: 9638399470 Enrollment ID: I20210823000401 |
| Provider Name | Sara H Perry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699443424 PECOS PAC ID: 3971996844 Enrollment ID: I20220616002146 |
| Provider Name | Morgan L Elsasser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588301477 PECOS PAC ID: 6608255823 Enrollment ID: I20220618000183 |
| Provider Name | Stephanie Hope Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942871363 PECOS PAC ID: 9638554256 Enrollment ID: I20220919001884 |
| Provider Name | Ezra Jay Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508517251 PECOS PAC ID: 0446620553 Enrollment ID: I20230106001271 |
| Provider Name | Sierra Rae Krall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679272454 PECOS PAC ID: 6406211978 Enrollment ID: I20230505001177 |
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