Provider Demographics
NPI:1164085593
Name:WOODY-GODSAVE, LINDA ANN (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:WOODY-GODSAVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:GODSAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:10206 GENESTA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1627
Mailing Address - Country:US
Mailing Address - Phone:818-404-0664
Mailing Address - Fax:
Practice Address - Street 1:1250 LA VENTA DR STE 112
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3756
Practice Address - Country:US
Practice Address - Phone:805-496-5153
Practice Address - Fax:805-496-5202
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty