Provider Demographics
NPI:1003141235
Name:WOOD, GLORIA DENISE
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:DENISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:DENISE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:30 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1927
Mailing Address - Country:US
Mailing Address - Phone:845-505-0598
Mailing Address - Fax:
Practice Address - Street 1:30 PARKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1927
Practice Address - Country:US
Practice Address - Phone:845-505-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268273-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse