=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669813093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE L WOOD CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2013
-----------------------------------------------------
Last Update Date | 07/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3811 O'HARA STREET WESTERN PSYCHIATRIC INSTITUE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 12513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-246-6652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1163 PEMBERTON ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-849-2899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP011043
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------