Provider Demographics
NPI:1417667718
Name:WOOD, JENNIFER LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEAF VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ELLAMORE
Mailing Address - State:WV
Mailing Address - Zip Code:26267-1402
Mailing Address - Country:US
Mailing Address - Phone:304-669-9833
Mailing Address - Fax:
Practice Address - Street 1:2673 OLD DAVISSON RUN ROAD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:681-342-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72808163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health