Healthcare Provider Details

I. General information

NPI: 1073275418
Provider Name (Legal Business Name): ELIZABETH D WOOD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD STE 129
MESA AZ
85206-4679
US

IV. Provider business mailing address

4824 E BASELINE RD STE 129
MESA AZ
85206-4679
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-1001
  • Fax: 480-464-8722
Mailing address:
  • Phone: 480-644-1001
  • Fax: 480-464-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number260905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: