Provider Demographics
NPI:1205484474
Name:WOOD, JENIFER ELIZABETH (CPM)
Entity type:Individual
Prefix:MISS
First Name:JENIFER
Middle Name:ELIZABETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MISSION RIDGE AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3248
Mailing Address - Country:US
Mailing Address - Phone:785-443-4048
Mailing Address - Fax:
Practice Address - Street 1:600 S MISSION RIDGE AVE APT 11
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3248
Practice Address - Country:US
Practice Address - Phone:785-443-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19080020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
19080020OtherNARM