Healthcare Provider Details

I. General information

NPI: 1720249881
Provider Name (Legal Business Name): ANGELA IRENE WOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E 23RD ST STE 200
FREMONT NE
68025-0800
US

IV. Provider business mailing address

1005 E 23RD ST STE 200
FREMONT NE
68025-0800
US

V. Phone/Fax

Practice location:
  • Phone: 866-784-2329
  • Fax: 877-550-6600
Mailing address:
  • Phone: 866-784-2329
  • Fax: 877-550-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000158151
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: