Provider Demographics
NPI:1386948537
Name:WOOD, MARY GAIL (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GAIL
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:435 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1606
Mailing Address - Country:US
Mailing Address - Phone:607-763-3481
Mailing Address - Fax:607-763-3363
Practice Address - Street 1:435 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1606
Practice Address - Country:US
Practice Address - Phone:607-763-3481
Practice Address - Fax:607-763-3363
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY122296672Medicaid