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General NPI Number Information
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NPI Number | 1043097785
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Entity Type | Individual
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Provider Name | LESLIE RAE WOOD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 10/07/2023
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Provider Practice Location Address
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Address Line | 1265 N 10TH ST
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City | LARAMIE
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State | WY
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Zip | 82072-2207
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Country | US
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Telephone | 307-399-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 1265 N 10TH ST
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City | LARAMIE
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State | WY
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Zip | 82072-2207
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Country | US
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Telephone | 307-399-0340
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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