MEDICARE: PATRICIA WOOD RN, FNP-BC

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	163W00000X	Registered Nurse	289005	CA
2	1744R1102X	Research Study Specialist
3	363LF0000X	Family Nurse Practitioner	5320	CA
4	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	26800	CA

General Provider Information

NPI Number	:	1871917393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WOOD RN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 3441
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91031-6441
Country	:	US
Telephone Number	:	626-298-2909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 FOOTHILL ST
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1717
Country	:	US
Telephone Number	:	626-441-0687
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	10/14/2015

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