MEDICARE: MICHELLE LEIGH WOOD NP

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	363LA2200X	Adult Health Nurse Practitioner	21168	SC
2	363LA2200X	Adult Health Nurse Practitioner	5011331	NC
3	363LG0600X	Gerontology Nurse Practitioner	5011331	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207GR	OTHER	NC	BCBSNC
2	5968776	OTHER	NC	CIGNA

General Provider Information

NPI Number	:	1881110559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEIGH WOOD NP

Provider Business Mailing Address
First Line	:	7810 BALLANTYNE COMMONS PKWY STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3416
Country	:	US
Telephone Number	:	704-342-0252
Fax Number	:	980-533-7806

Provider Business Practice Location Address
First Line	:	7810 BALLANTYNE COMMONS PKWY STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3416
Country	:	US
Telephone Number	:	704-342-0252
Fax Number	:	980-533-7806

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	06/12/2026

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