Summit Advance Mobile Wound Care LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

SUMMIT ADVANCE MOBILE WOUND CARE LLC

Practice address

6773 Deerwood LN N
Maple Grove, MN 55369-5530

Phone

(612) 598-8555

NPI assigned

Jan 24, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Henry Momanyi, NPNPI 1679207013

Title

Nurse Practitioner

Phone

(612) 598-8555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Henry Momanyi

  • Family Nurse Practitioner
  • Maple Grove, MN
  • NPI 1679207013
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1737676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1316759566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6773 DEERWOOD LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695530",
            "telephone_number": "612-598-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6773 DEERWOOD LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695530",
            "telephone_number": "612-598-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT ADVANCE MOBILE WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-24",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "MOMANYI",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "612-598-8555",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Marie Strom, OTD, OTR/L
• Tiffany Sandra Linda Stroman
• Stuck Holdings, Inc.
• Suite Living Senior Care of Maple Grove
• Bryan Daniel Sullivan, D.C.
• Summit Orthopedics, LTD
• Jacob Jared Sundberg, D.C.
• Sunny Dental P.C.
• Supervalu Pharmacies Inc
• Britta Jessica Svihel, LPC, LADC

• Family Nurse Practitioner in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.