Provider Demographics
NPI:1023542719
Name:WOODFILL, DANIEL ERNEST
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ERNEST
Last Name:WOODFILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25145 DURANT ST. N.E.
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040
Mailing Address - Country:US
Mailing Address - Phone:763-444-6328
Mailing Address - Fax:
Practice Address - Street 1:22145 DURANT ST. N.E.
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040
Practice Address - Country:US
Practice Address - Phone:763-744-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications