Provider Demographics
NPI:1780988550
Name:WOOD, LORENA TEUTLI (LPN)
Entity type:Individual
Prefix:MS
First Name:LORENA
Middle Name:TEUTLI
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 GLEN HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1140
Mailing Address - Country:US
Mailing Address - Phone:513-254-6514
Mailing Address - Fax:
Practice Address - Street 1:1234 GLEN HAVEN LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1140
Practice Address - Country:US
Practice Address - Phone:513-254-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 138476-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse