Healthcare Provider Details

I. General information

NPI: 1871917393
Provider Name (Legal Business Name): PATRICIA WOOD RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA WOOD RN, FNP-BC

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 FOOTHILL ST
SOUTH PASADENA CA
91030-1717
US

IV. Provider business mailing address

PO BOX 3441
SOUTH PASADENA CA
91031-6441
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-0687
  • Fax:
Mailing address:
  • Phone: 626-298-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number289005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5320
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number26800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: