Provider Demographics
NPI:1891451365
Name:WOOD, JOHN MOO (APRN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MOO
Last Name:WOOD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BUTTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:CUTTINGSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05738-4401
Mailing Address - Country:US
Mailing Address - Phone:802-492-3207
Mailing Address - Fax:
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10023363L00000X
VT101.0137193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner