Provider Demographics
NPI:1285181974
Name:WOOD, LENA SOO HEE (CNM)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:SOO HEE
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 1:7025 27TH ST W STE 6
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5221
Mailing Address - Country:US
Mailing Address - Phone:253-260-4328
Mailing Address - Fax:253-260-4328
Practice Address - Street 1:7025 27TH ST W STE 6
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5221
Practice Address - Country:US
Practice Address - Phone:253-260-4328
Practice Address - Fax:253-260-4328
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608618NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717325Medicaid
WA2068504Medicaid
OR500717325Medicaid