Basic Information
| Provider Information | |||||||||
| NPI: | 1366402661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1393 CELANESE RD | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297321722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033293103 | ||||||||
| FaxNumber: | 8033252232 | ||||||||
| Practice Location | |||||||||
| Address1: | 1393 CELANESE RD | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297321722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033293103 | ||||||||
| FaxNumber: | 8033252232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN 1074 | SC | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | APN 1074 | SC | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LX0106X | APN 1074 | SC | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
ID Information
| ID | Type | State | Issuer | Description | D4220 | 01 | MEDCOST | OTHER | NP0536 | 05 | SC | MEDICAID |