Provider Demographics
NPI:1912246018
Name:WOOD, MARY ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WEST 2ND AVENUE
Mailing Address - Street 2:P O BOX 703
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583
Mailing Address - Country:US
Mailing Address - Phone:843-493-1039
Mailing Address - Fax:
Practice Address - Street 1:419 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2541
Practice Address - Country:US
Practice Address - Phone:843-669-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse