Healthcare Provider Details

I. General information

NPI: 1275238677
Provider Name (Legal Business Name): MICHELLE DEANN WOOD MSN, RN, AGCNS-BC, C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11108 PARKVIEW CIRCLE DR
FORT WAYNE IN
46845-1730
US

IV. Provider business mailing address

212 CORNER STONE PKWY
FORT WAYNE IN
46825-8137
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-2260
  • Fax:
Mailing address:
  • Phone: 260-602-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28092022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: