Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN043346 | LA |
NPI | 1356575161 |
---|---|
Provider Name | Delores M. Wood |
First Address | West Monroe, LA 71294-5805 |
Second Address | West Monroe, LA 71291-5327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 22/06/2009 |