Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 12578 | TX |
Y | 111NP0017X | Pediatric Chiropractor | 12578 | TX |
NPI | 1528484946 |
---|---|
Provider Name | Dr. Shauna Annie Wood |
First Address | Georgetown, TX 78626-8208 |
Second Address | Georgetown, TX 78626-8208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 09/09/2014 |