Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 260905 | AZ |
NPI | 1073275418 |
---|---|
Provider Name | Elizabeth Wood |
First Address | Mesa, AZ 85201-6301 |
Second Address | Mesa, AZ 85201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2021 |
Last Update Date | 13/10/2021 |