Healthcare Provider Details

I. General information

NPI: 1295238509
Provider Name (Legal Business Name): BERNADETTE MORRISSEY WOOD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DENTON PLZ
DENTON MD
21629-9501
US

IV. Provider business mailing address

8200 NEW BRIDGE RD
DENTON MD
21629-1659
US

V. Phone/Fax

Practice location:
  • Phone: 443-606-2300
  • Fax:
Mailing address:
  • Phone: 410-490-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR164214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: