Provider Demographics
NPI:1285994418
Name:WOOD, MICHAEL ERWIN (LPN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ERWIN
Last Name:WOOD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HUSKIE LANE
Mailing Address - Street 2:NFEC -
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953
Mailing Address - Country:US
Mailing Address - Phone:518-483-5230
Mailing Address - Fax:518-483-1399
Practice Address - Street 1:23 HUSKIE LANE
Practice Address - Street 2:NFEC -
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-5230
Practice Address - Fax:518-483-1399
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168205-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse