Healthcare Provider Details

I. General information

NPI: 1144820077
Provider Name (Legal Business Name): KAREN WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 W MAIN RD BLDG 3
MIDDLETOWN RI
02842-6335
US

IV. Provider business mailing address

1272 W MAIN RD
MIDDLETOWN RI
02842-6405
US

V. Phone/Fax

Practice location:
  • Phone: 401-847-2290
  • Fax: 401-849-8446
Mailing address:
  • Phone: 401-847-2290
  • Fax: 401-849-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN02501
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: