Provider Demographics
NPI:1861615023
Name:WOOD, CAROL LOUISE (RD, LN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 LEEANN BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0422
Mailing Address - Country:US
Mailing Address - Phone:406-651-8791
Mailing Address - Fax:
Practice Address - Street 1:3201 LEEANN BLVD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0422
Practice Address - Country:US
Practice Address - Phone:406-651-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0280319Medicaid