Healthcare Provider Details

I. General information

NPI: 1144667221
Provider Name (Legal Business Name): HELEN WOOD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 DREW AVE S
EDINA MN
55435-2103
US

IV. Provider business mailing address

6525 DREW AVE S
EDINA MN
55435-2103
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-6748
  • Fax: 952-920-3863
Mailing address:
  • Phone: 952-920-6748
  • Fax: 952-920-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47594
License Number StateMN

VIII. Authorized Official

Name: HELEN WOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 952-920-6748