Basic Information
| Provider Information | |||||||||
| NPI: | 1467580647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RN NURSE PRACTITIONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 SKYLINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799675570 | ||||||||
| FaxNumber: | 4798905364 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 SKYLINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799675570 | ||||||||
| FaxNumber: | 4798905364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R22102 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | P00397 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.