Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wound Company Provider Group, Inc

Organization Continence Care Registered Nurse · NPI 1114635174

Wound Company Provider Group, Inc is a Continence Care Registered Nurse in Minneapolis, Minnesota. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
3
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2240 Drew Ave S
Minneapolis, MN 55416-3646
Phone: (858) 774-6305
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Wound Care Registered Nurse (primary) Taxonomy 163WW0000X
Continence Care Registered Nurse Taxonomy 163WC2100X
Enterostomal Therapy Registered Nurse Taxonomy 163WE0900X

Record details

NPI number1114635174
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brantley Jolly — President · (703) 447-6897
Other names Sanford E Roberts Iii Md, Inc.
NPI enumeratedNovember 9, 2022
Last updated in NPPESJuly 18, 2023
Certification dateJuly 18, 2023
Mailing address2240 Drew Ave S, Minneapolis, MN 55416-3646

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