Healthcare Provider Details

I. General information

NPI: 1053291781
Provider Name (Legal Business Name): PAUL WOOD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 10/24/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 S HILLHOUSE CV # 102
MURRAY UT
84107-3886
US

IV. Provider business mailing address

4706 S HILLHOUSE CV # 102
MURRAY UT
84107-3886
US

V. Phone/Fax

Practice location:
  • Phone: 225-907-6248
  • Fax:
Mailing address:
  • Phone: 225-907-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number134383753102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: