Provider Demographics
NPI:1407279524
Name:WOOD, GRETE (APN)
Entity Type:Individual
Prefix:
First Name:GRETE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GRETE
Other - Middle Name:
Other - Last Name:DIETLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 ADAMS PL STE 305
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7456
Mailing Address - Country:US
Mailing Address - Phone:617-302-4194
Mailing Address - Fax:
Practice Address - Street 1:2 ADAMS PL STE 305
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7456
Practice Address - Country:US
Practice Address - Phone:617-302-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily