Healthcare Provider Details

I. General information

NPI: 1922678564
Provider Name (Legal Business Name): LESLY WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

5 BRADY ST
WARREN RI
02885-2022
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-1690
  • Fax: 508-973-1715
Mailing address:
  • Phone: 508-264-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2303986
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN26303986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: