Provider Demographics
NPI:1114568607
Name:WOOD, GEORGENE CLEMENTS (NP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGENE
Middle Name:CLEMENTS
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:GEORGENE
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 N. 11TH ST.
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-628-6658
Mailing Address - Fax:804-827-1744
Practice Address - Street 1:417 N. 11TH ST.
Practice Address - Street 2:5TH FLOOR
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-628-6658
Practice Address - Fax:804-827-1744
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily