Provider Demographics
NPI:1164408522
Name:WOODALL, JANICE ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:ANN
Last Name:WOODALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1833
Mailing Address - Country:US
Mailing Address - Phone:712-225-0191
Mailing Address - Fax:712-225-0196
Practice Address - Street 1:213 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1833
Practice Address - Country:US
Practice Address - Phone:712-225-0191
Practice Address - Fax:712-225-0196
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA051371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291328Medicaid
IA0291328Medicaid
R80981Medicare UPIN