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General NPI Number Information
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NPI Number | 1588659874
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Entity Type | Individual
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Provider Name | MELANIE JUNEQ WOOD PA
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Gender | Female
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER
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City | FT LEWIS
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State | WA
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Zip | 98433
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Country | US
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Telephone | 253-968-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S 336TH ST SUITE 600
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6328
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Country | US
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Telephone | 253-838-6180
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Fax | 253-838-6418
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10001997
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License Number State | WA
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