1881630069 NPI number — DR. JANITH CAROLYN WOOD DSN CRNP

Table of content: DR. JANITH CAROLYN WOOD DSN CRNP (NPI 1881630069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881630069 NPI number — DR. JANITH CAROLYN WOOD DSN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JANITH
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSN CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881630069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MEMORIAL HOSPITAL DR 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-414-5900
Provider Business Mailing Address Fax Number:
251-281-1163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 K DAUPHIN ISLAND PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36605-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-476-6330
Provider Business Practice Location Address Fax Number:
251-473-1086
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1033492 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51533951 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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