Provider Demographics
NPI:1821545526
Name:WOOD, KATHRIN S (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRIN
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KATHRIN
Other - Middle Name:S
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:56 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1934
Mailing Address - Country:US
Mailing Address - Phone:845-741-2752
Mailing Address - Fax:
Practice Address - Street 1:56 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1934
Practice Address - Country:US
Practice Address - Phone:845-741-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295820164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse