Provider Demographics
NPI:1336136621
Name:WOOD, MICHELLE KATHRYN (RN, CNS, LNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN, CNS, LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-4632
Mailing Address - Country:US
Mailing Address - Phone:540-434-1941
Mailing Address - Fax:540-433-8277
Practice Address - Street 1:1241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-434-1941
Practice Address - Fax:540-433-8277
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017138329363LP0808X
VA0001143842163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945166Medicaid
VA004945166Medicaid
VA016564H36Medicare PIN