Provider Demographics
NPI:1841833290
Name:WOOD, NICHOLAS ALLEN (RD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 E MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4777
Mailing Address - Country:US
Mailing Address - Phone:509-924-1826
Mailing Address - Fax:509-598-2121
Practice Address - Street 1:10807 E MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4777
Practice Address - Country:US
Practice Address - Phone:509-924-1826
Practice Address - Fax:509-598-2121
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered