Provider Demographics
NPI:1578856043
Name:WOOD, ANITA MARIE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 INGERSOLL AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-3604
Mailing Address - Country:US
Mailing Address - Phone:651-231-8061
Mailing Address - Fax:
Practice Address - Street 1:715 E 78TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1397
Practice Address - Country:US
Practice Address - Phone:612-873-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2010007724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily