Provider Demographics
NPI:1609682707
Name:VIRIDIS WOUND MANAGEMENT PLLC
Entity type:Organization
Organization Name:VIRIDIS WOUND MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-954-2184
Mailing Address - Street 1:5111 S HOGAN LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-8140
Mailing Address - Country:US
Mailing Address - Phone:509-954-2184
Mailing Address - Fax:
Practice Address - Street 1:850 E SPOKANE FALLS BLVD STE 133
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2171
Practice Address - Country:US
Practice Address - Phone:509-954-2184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty