Provider Demographics
NPI:1033359328
Name:WOODARD, MARJORIE SHANTAY
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:SHANTAY
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15511 WINTER BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2801
Mailing Address - Country:US
Mailing Address - Phone:832-893-3315
Mailing Address - Fax:281-835-8386
Practice Address - Street 1:15511 WINTER BRIAR DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2801
Practice Address - Country:US
Practice Address - Phone:832-893-3315
Practice Address - Fax:281-835-8386
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA06725436251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health