Provider Demographics
NPI:1083214035
Name:WOODSON, MARNIE CORRINE (LPN)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:CORRINE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 LOWER ELWHA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9518
Mailing Address - Country:US
Mailing Address - Phone:360-406-0443
Mailing Address - Fax:
Practice Address - Street 1:716 S CHASE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6122
Practice Address - Country:US
Practice Address - Phone:360-395-2976
Practice Address - Fax:360-395-2977
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60800385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse