Provider Demographics
NPI:1205021474
Name:WOOD, MINNIE ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:MINNIE
Middle Name:ELIZABETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MINNIE
Other - Middle Name:ELIZABETH
Other - Last Name:CANCELLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S 4TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1046
Mailing Address - Country:US
Mailing Address - Phone:702-380-8118
Mailing Address - Fax:702-380-2929
Practice Address - Street 1:1200 S 4TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1046
Practice Address - Country:US
Practice Address - Phone:702-380-8118
Practice Address - Fax:702-380-2929
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661205163W00000X
CA17447363L00000X
NVAPRN001647363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner