Provider Demographics
NPI:1790353118
Name:WOOD, LINDA WOOD DIANE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA WOOD
Middle Name:DIANE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 TORTHAY PL
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2875
Mailing Address - Country:US
Mailing Address - Phone:208-983-8051
Mailing Address - Fax:
Practice Address - Street 1:1516 TORTHAY PL
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2875
Practice Address - Country:US
Practice Address - Phone:208-983-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00158437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse