Provider Demographics
NPI:1154906154
Name:WOOD, LETITIA YOUNGBLOOD
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:YOUNGBLOOD
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N JAMES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3171
Mailing Address - Country:US
Mailing Address - Phone:302-543-4425
Mailing Address - Fax:
Practice Address - Street 1:240 N JAMES ST STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3171
Practice Address - Country:US
Practice Address - Phone:302-543-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health