Basic Information
| Provider Information | |||||||||
| NPI: | 1699209585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | DENA | ||||||||
| MiddleName: | LASHON | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 SELMAN AVE | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307471751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063311326 | ||||||||
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| Practice Location | |||||||||
| Address1: | 302 SHORTER AVE NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301654268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062913700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2017 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN118419 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.