Provider Demographics
NPI:1861155236
Name:WOOD, STEPHANIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843-2528
Mailing Address - Country:US
Mailing Address - Phone:904-318-3502
Mailing Address - Fax:
Practice Address - Street 1:626 E 9TH ST
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843-2528
Practice Address - Country:US
Practice Address - Phone:904-318-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW418176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife