Provider Demographics
NPI:1598063406
Name:BINGHAM-WOODS, LAWANDA E (RN, MSN)
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:E
Last Name:BINGHAM-WOODS
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 S. UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827
Mailing Address - Country:US
Mailing Address - Phone:773-230-8092
Mailing Address - Fax:708-841-1697
Practice Address - Street 1:14202 S UNION AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-2317
Practice Address - Country:US
Practice Address - Phone:773-230-8092
Practice Address - Fax:708-841-1697
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-254055163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice