MEDICARE: MS. KATHLEEN P WOOD RN-CFNP

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	363LF0000X	Family Nurse Practitioner	153988	CA

General Provider Information

NPI Number	:	1447241948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN P WOOD RN-CFNP

Provider Business Mailing Address
First Line	:	532 MERIDIAN AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1736
Country	:	US
Telephone Number	:	626-441-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	4448 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3328
Country	:	US
Telephone Number	:	323-344-5233
Fax Number	:	323-344-5237

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/08/2007

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