Provider Demographics
NPI:1194794990
Name:WOOD, JOANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 NEWBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-221-0112
Mailing Address - Fax:
Practice Address - Street 1:781 NEWBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:N BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-221-0112
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse