Healthcare Provider Details

I. General information

NPI: 1619082187
Provider Name (Legal Business Name): JOYCE WOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

2059 HARTS LN
CONSHOHOCKEN PA
19428-2414
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-4292
  • Fax:
Mailing address:
  • Phone: 610-825-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP005166C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: