Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024177389 | VA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN267871 | GA |
N | 363LA2100X | Nurse Practitioner - Acute Care | SP013196 | PA |
NPI | 1033522859 |
---|---|
Provider Name | Samantha Leigh Wood |
First Address | Richmond, VA 23230 |
Second Address | Richmond, VA 23230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 09/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102996334 | (05) | PA |