Healthcare Provider Details

I. General information

NPI: 1508059890
Provider Name (Legal Business Name): DALLENA ANN WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DALLENA ANN WOOD R.N.

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

4951 NETARTS HWY W PMB 2664
TILLAMOOK OR
97141-9467
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-4000
  • Fax:
Mailing address:
  • Phone: 661-742-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number669355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: