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General NPI Number Information
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NPI Number | 1639738057
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Entity Type | Individual
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Provider Name | MS. LISA WOOD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 101 N RANGE LINE RD STE 304
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City | JOPLIN
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State | MO
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Zip | 64801-4118
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Country | US
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Telephone | 417-206-7845
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Fax | 417-782-6337
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Provider Business Mailing Address
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Address Line | 502 N BYERS AVE
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City | JOPLIN
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State | MO
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Zip | 64801-2716
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Country | US
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Telephone | 417-825-5700
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Fax | 417-782-6331
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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 | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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