Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Wound Care |
163WW0000X |
| NPI # | 1144016700 |
| LBN Legal business name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Authorized official | JANA CONROY - (DIRECTOR OF CREDENTIALING) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 04/18/2025 |
| Last updated | 04/18/2025 - More than a year ago |
| Identifiers | n/a |
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