Provider Demographics
NPI:1689437550
Name:WOOD, JACINTA
Entity Type:Individual
Prefix:
First Name:JACINTA
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 1:8610 S MARYLAND PKWY APT 1013
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2710
Mailing Address - Country:US
Mailing Address - Phone:702-415-9073
Mailing Address - Fax:
Practice Address - Street 1:8610 S MARYLAND PKWY APT 1013
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2710
Practice Address - Country:US
Practice Address - Phone:702-415-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV175M00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175M00000XOther Service ProvidersMidwife, Lay