Healthcare Provider Details

I. General information

NPI: 1558090324
Provider Name (Legal Business Name): ANGELA WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 W MAPLE RD STE 124
OMAHA NE
68164-6231
US

IV. Provider business mailing address

13808 W MAPLE RD STE 124
OMAHA NE
68164-6231
US

V. Phone/Fax

Practice location:
  • Phone: 515-207-5251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0917
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: