Healthcare Provider Details

I. General information

NPI: 1992241319
Provider Name (Legal Business Name): VALERIE WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE FANELLI

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 W BALTIMORE PIKE STE 3109
MEDIA PA
19063-5139
US

IV. Provider business mailing address

1098 W BALTIMORE PIKE STE 3109
MEDIA PA
19063-5139
US

V. Phone/Fax

Practice location:
  • Phone: 484-443-2880
  • Fax:
Mailing address:
  • Phone: 484-443-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP016703
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: