Provider Demographics
NPI:1073998688
Name:WOOD, BRENDA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEYERSDORFER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-8605
Mailing Address - Country:US
Mailing Address - Phone:845-339-7661
Mailing Address - Fax:
Practice Address - Street 1:22 BEYERSDORFER ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-8605
Practice Address - Country:US
Practice Address - Phone:845-339-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8158093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse