Provider Demographics
NPI:1780934810
Name:WOOD, SUE ANN (MS, RN, ANP-BC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, RN, ANP-BC
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:NEEDHAM-WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RN, ANP-BC
Mailing Address - Street 1:2889 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2123
Mailing Address - Country:US
Mailing Address - Phone:269-343-1247
Mailing Address - Fax:269-343-6661
Practice Address - Street 1:2889 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2123
Practice Address - Country:US
Practice Address - Phone:269-343-1247
Practice Address - Fax:269-343-6661
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117933363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health