Provider Demographics
NPI:1164211538
Name:HIGH DESERT WOUND CARE
Entity type:Organization
Organization Name:HIGH DESERT WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:LASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,FNP-BC
Authorized Official - Phone:928-377-0355
Mailing Address - Street 1:3856 N BONITA RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-9353
Mailing Address - Country:US
Mailing Address - Phone:928-377-0355
Mailing Address - Fax:
Practice Address - Street 1:3856 N BONITA RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-9353
Practice Address - Country:US
Practice Address - Phone:928-377-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty