Provider Demographics
NPI:1013193168
Name:WOOD, TIMOTHY P (LPN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:WOOD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4093 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-4544
Mailing Address - Country:US
Mailing Address - Phone:414-421-0543
Mailing Address - Fax:
Practice Address - Street 1:4093 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-4544
Practice Address - Country:US
Practice Address - Phone:414-421-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse