Provider Demographics
NPI:1679743298
Name:ELWOOD, KENNETH (RN, CMT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:ELWOOD
Suffix:
Gender:M
Credentials:RN, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 W MILLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:MI
Mailing Address - Zip Code:48435-9725
Mailing Address - Country:US
Mailing Address - Phone:989-795-2641
Mailing Address - Fax:
Practice Address - Street 1:1673 W MILLINGTON RD
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:MI
Practice Address - Zip Code:48435-9725
Practice Address - Country:US
Practice Address - Phone:989-795-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704202174163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management