Healthcare Provider Details

I. General information

NPI: 1386154391
Provider Name (Legal Business Name): MICHELLE PATRICIA WOOD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

22220 AUDETTE ST
DEARBORN MI
48124-4703
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5000
  • Fax:
Mailing address:
  • Phone: 313-623-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704278104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: