| Organization Name: | MOBILE WOUND CARE CONSULTANT LLC |
| NPI Number: | 1063882116 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BONNAFE BATICADOS (OWNER) |
| Mailing Address: | 3241 Justamere Rd Woodridge |
| State: | IL US |
| Postal Code: | 605173759 |
| Phone Number: | 6305448517 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2015 |
| NPI Last Update Date: | 10/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WW0000X |
| License Number: | 041.280969 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Wound Care |
| Taxonomy Definition: | |