Provider Demographics
NPI:1104842442
Name:WOOD, LINA LEIGH (CNM)
Entity Type:Individual
Prefix:MS
First Name:LINA
Middle Name:LEIGH
Last Name:WOOD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9133 TIMBER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9075
Mailing Address - Country:US
Mailing Address - Phone:843-818-1123
Mailing Address - Fax:843-818-1126
Practice Address - Street 1:9133 TIMBER ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9075
Practice Address - Country:US
Practice Address - Phone:843-818-1123
Practice Address - Fax:843-818-1126
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC436367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0189Medicaid
SC436OtherSC LICENSE