| Doctor Name: | MRS. SHANNON M WOOD |
| NPI Number: | 1003293762 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 2015007598 |
| Business Practice Address: | 9209 Phoenix Village Pkwy O Fallon, MO - 633684280 |
| Business Phone Number: | 6365614613 |
| Business Fax Number: | 6365614610 |
| Mailing Address: | 801 York St, MANITOWOC |
| State: | WI |
| Postal Code: | 542204630 |
| Phone Number: | 9206639016 |
| Fax Number: | 9206841439 |
| NPI Enumeration Date: | 05/01/2015 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2015007598 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |