Provider Demographics
NPI:1962974634
Name:WOOD, LAURIE SUE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5662
Mailing Address - Country:US
Mailing Address - Phone:253-351-4828
Mailing Address - Fax:253-931-4705
Practice Address - Street 1:711 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5662
Practice Address - Country:US
Practice Address - Phone:253-351-4828
Practice Address - Fax:253-931-4705
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00103943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse