Provider Demographics
NPI:1447466099
Name:WOOD, SUSAN ROSE (NNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROSE
Last Name:WOOD
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15210 MARBLEHEAD CT
Mailing Address - Street 2:COLORADO SPRINGS
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3500
Mailing Address - Country:US
Mailing Address - Phone:719-432-8815
Mailing Address - Fax:
Practice Address - Street 1:6001 E WOODMEN RD
Practice Address - Street 2:COLORADO SPRINGS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2601
Practice Address - Country:US
Practice Address - Phone:719-571-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80122363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80122OtherEPIC