Healthcare Provider Details

I. General information

NPI: 1265456198
Provider Name (Legal Business Name): DENISE WOOD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST SUITE 4F
DETROIT MI
48201-2153
US

IV. Provider business mailing address

37993 PALMA RD
NEW BOSTON MI
48164-9516
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4380
  • Fax:
Mailing address:
  • Phone: 734-654-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704225983
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: