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General NPI Number Information
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NPI Number | 1598824591
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Entity Type | Individual
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Provider Name | KELLERYN V WOOD F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 800 MAIN ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6049
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Country | US
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Telephone | 207-828-1133
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Fax | 207-828-8077
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Provider Business Mailing Address
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Address Line | 800 MAIN ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6049
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Country | US
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Telephone | 207-828-1133
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Fax | 207-828-8077
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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 | 363L00000X
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License Number State | ME
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