Healthcare Provider Details

I. General information

NPI: 1982105144
Provider Name (Legal Business Name): LINDA WOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 E APPLE AVE
MUSKEGON MI
49442-3071
US

IV. Provider business mailing address

5571 E APPLE AVE
MUSKEGON MI
49442-3071
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-4353
  • Fax: 231-728-4370
Mailing address:
  • Phone: 231-728-4353
  • Fax: 231-728-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704218242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: