Advanced Wound Care LLC

Organization Active NPI Nurse Practitioner · Springfield, IL

NPI 1528084266 · NPPES record last updated Jan 16, 2008

Key facts

NPI
1528084266
Entity type
Organization (NPI type 2)
Primary specialty
Nurse Practitioner 363L00000X
Legal business name
ADVANCED WOUND CARE LLC
Practice address
2524 Farragut Dr # C
Springfield, IL 62704-8400
Phone
(217) 698-3505
Fax
(217) 698-3502
NPI assigned
Jul 14, 2006
Organization subpart
No

Authorized official

Name
Mrs. Roxanne Leisky, NP CWC
Title
Owner
Phone
(217) 698-3505

Practitioners 2

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

National Provider Directory

Locations

2524 Farragut Dr
#C
Springfield, IL 62704
Phone (217) 698-3505

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP
363L00000X Yes

Addresses

Primary practice location

2524 Farragut Dr # C
Springfield, IL 62704-8400

Mailing address

426 Tyrone Dr
Forsyth, IL 62535-1069
Phone (217) 698-3505

Other identifiers

IdentifierTypeStateIssuer
1528084266OtherILNPI GROUP
05832068OtherILBC BS OF IL
30-0024900OtherILTAX ID
DE5770OtherILRR MEDICARE GROUP NUMBER

Other providers in Springfield, IL

All providers in Springfield, IL · Nurse Practitioner in Illinois

Sources for this page

Verify at the official NPI Registry.