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General NPI Number Information
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NPI Number | 1003293762
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Entity Type | Individual
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Provider Name | SHANNON M WOOD FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 9209 PHOENIX VILLAGE PKWY
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City | O FALLON
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State | MO
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Zip | 63368-4280
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Country | US
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Telephone | 636-561-4613
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Fax | 636-561-4610
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9016
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Fax | 920-684-1439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015007598
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License Number State | MO
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