Provider Demographics
NPI:1457877110
Name:WOOD, LARESE (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:LARESE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20505 COOLIDGE
Mailing Address - Street 2:
Mailing Address - City:OAKPARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237
Mailing Address - Country:US
Mailing Address - Phone:248-632-7411
Mailing Address - Fax:
Practice Address - Street 1:26505 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1114
Practice Address - Country:US
Practice Address - Phone:248-632-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator