Provider Demographics
NPI:1891901450
Name:ROOD, WAYNE L (RN)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:L
Last Name:ROOD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 TROUT BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6749
Mailing Address - Country:US
Mailing Address - Phone:715-386-8683
Mailing Address - Fax:
Practice Address - Street 1:391 TROUT BROOK TRL
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-6749
Practice Address - Country:US
Practice Address - Phone:715-386-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR097379-7OtherMN NURSING LICENSE