Provider Demographics
NPI:1861883761
Name:WOOD, LYNN M (PAC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:WOOD
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:3355 RIVERBEND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8800
Mailing Address - Country:US
Mailing Address - Phone:541-485-6478
Mailing Address - Fax:541-868-9606
Practice Address - Street 1:1077 GATEWAY LOOP
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1114
Practice Address - Country:US
Practice Address - Phone:541-485-6478
Practice Address - Fax:541-485-0452
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2025-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA171173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1861883761OtherNPI