Provider Demographics
NPI:1639738057
Name:WOOD, LISA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N BYERS AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2716
Mailing Address - Country:US
Mailing Address - Phone:417-825-5700
Mailing Address - Fax:417-782-6331
Practice Address - Street 1:101 N RANGE LINE RD STE 304
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4118
Practice Address - Country:US
Practice Address - Phone:417-206-7845
Practice Address - Fax:417-782-6337
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory