Provider Demographics
NPI:1023074465
Name:WOOD, GWENDOLEN (PNP)
Entity type:Individual
Prefix:
First Name:GWENDOLEN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-7685
Practice Address - Street 1:7501 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3367
Practice Address - Country:US
Practice Address - Phone:806-793-7257
Practice Address - Fax:806-799-1568
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX507591363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S76958Medicare UPIN
8D7363Medicare ID - Type Unspecified