Provider Demographics
NPI:1164114344
Name:WOODS, KATELYNN
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:WOODS
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 1:1825 BERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-2711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 BERVILLE RD
Practice Address - Street 2:
Practice Address - City:ALLENTON
Practice Address - State:MI
Practice Address - Zip Code:48002-2711
Practice Address - Country:US
Practice Address - Phone:586-480-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704360335163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine