Provider Demographics
NPI:1598998981
Name:WOOD, BRANDI (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1139
Mailing Address - Country:US
Mailing Address - Phone:217-347-2500
Mailing Address - Fax:217-342-9775
Practice Address - Street 1:900 W TEMPLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-347-2500
Practice Address - Fax:217-342-9775
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043074814164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse