Healthcare Provider Details

I. General information

NPI: 1033785118
Provider Name (Legal Business Name): CYNTHIA KAY WOOD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 N 12TH ST STE 103
PHOENIX AZ
85014-4250
US

IV. Provider business mailing address

4520 N 12TH ST STE 103
PHOENIX AZ
85014-4250
US

V. Phone/Fax

Practice location:
  • Phone: 602-753-2345
  • Fax: 602-419-3062
Mailing address:
  • Phone: 602-753-2345
  • Fax: 602-419-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: