Basic Information
| Provider Information | |||||||||
| NPI: | 1902416258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280544581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283340402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1223 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083488009 | ||||||||
| FaxNumber: | 9808349879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2020 | ||||||||
| LastUpdateDate: | 12/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201792 | NC | N | Nursing Service Providers | Registered Nurse | 363LF0000X | WOOD-TQBDS | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.