Provider Demographics
NPI:1881264372
Name:WOOD, LISA YVETTE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:YVETTE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SHELTER COVE ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2919
Mailing Address - Country:US
Mailing Address - Phone:443-962-5092
Mailing Address - Fax:410-724-1926
Practice Address - Street 1:606 SHELTER COVE ST
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2919
Practice Address - Country:US
Practice Address - Phone:443-962-5092
Practice Address - Fax:410-724-1926
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR5054P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health