Provider Demographics
NPI:1174494223
Name:PETERS-WOOD, CARMEN KAY
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:KAY
Last Name:PETERS-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 1:120 ELK DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9539
Mailing Address - Country:US
Mailing Address - Phone:307-708-0133
Mailing Address - Fax:
Practice Address - Street 1:120 ELK DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9539
Practice Address - Country:US
Practice Address - Phone:307-708-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator