OrganizationActive
Proactive Wound Care Id Inc.
NPI 1134928419 · Podiatrist · Fish Haven, ID
Provider details
- NPI number
- 1134928419
- Entity type
- Organization
- Primary specialty
- PodiatristPodiatric Medicine & Surgery Service Providers
- Organization subpart
- No
- Authorized official
- Hayley Williams, Office Manager(801) 815-6862
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
- Nurse Practitioner363L00000X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
2270 Highway 89
Fish Haven, ID 83287-5139
Phone: (801) 815-6862
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 607
Centerville, UT 84014-0607
Registry dates
- Enumerated
- 2025-03-10
- Last updated
- 2025-03-10
- Certified
- 2025-03-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.