Provider Demographics
NPI:1326187709
Name:WOOD, DIANA RENE (RN BSN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RENE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N CLAY ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-2844
Mailing Address - Country:US
Mailing Address - Phone:940-761-7841
Mailing Address - Fax:940-761-7885
Practice Address - Street 1:1700 3RD ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2113
Practice Address - Country:US
Practice Address - Phone:940-761-7697
Practice Address - Fax:940-761-7885
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX701423171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX701423OtherREGISTERED NURSE