MEDICARE: SAMANTHA LEIGH WOOD N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP013196	PA
2	363LA2100X	Acute Care Nurse Practitioner	RN267871	GA
3	363LA2100X	Acute Care Nurse Practitioner	0024177389	VA

General Provider Information

NPI Number	:	1033522859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LEIGH WOOD N.P.

Provider Business Mailing Address
First Line	:	5901 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2219
Country	:	US
Telephone Number	:	804-249-8888
Fax Number	:	804-249-7246

Provider Business Practice Location Address
First Line	:	5901 W BROAD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2219
Country	:	US
Telephone Number	:	804-249-8888
Fax Number	:	804-249-7246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	08/15/2023

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