Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | F381419 | NY |
NPI | 1013090463 |
---|---|
Provider Name | Charene Wood |
First Address | Amherst, NY 14226-3803 |
Second Address | Buffalo, NY 14222-2006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02175693 | (05) | NY |