Provider Demographics
NPI:1730858499
Name:WOOD, ANGELA DAWN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
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:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0521
Mailing Address - Country:US
Mailing Address - Phone:701-648-8597
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE NW # 521
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3225
Practice Address - Country:US
Practice Address - Phone:701-648-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty