Provider Demographics
NPI:1730443821
Name:WOUND TECHNOLOGY NETWORK
Entity type:Organization
Organization Name:WOUND TECHNOLOGY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:954-923-7440
Mailing Address - Street 1:2536 NASSAU LN
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4618
Mailing Address - Country:US
Mailing Address - Phone:954-554-3447
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6927
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:954-923-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1966952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty