Provider Demographics
NPI:1033522859
Name:WOOD, SAMANTHA LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2219
Mailing Address - Country:US
Mailing Address - Phone:804-249-8888
Mailing Address - Fax:804-249-7246
Practice Address - Street 1:5901 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2219
Practice Address - Country:US
Practice Address - Phone:804-249-8888
Practice Address - Fax:804-249-7246
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013196363LA2100X
GARN267871363LA2100X
VA0024177389363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102996334Medicaid
PA102996334Medicaid