Provider Demographics
NPI:1225253412
Name:WOODNEV
Entity Type:Organization
Organization Name:WOODNEV
Other - Org Name:LYMPHEDEMA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:WONER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOODILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LYMPHEDEMA THERAPIST
Authorized Official - Phone:239-435-1497
Mailing Address - Street 1:990 8TH ST S
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8215
Mailing Address - Country:US
Mailing Address - Phone:239-435-1497
Mailing Address - Fax:
Practice Address - Street 1:990 8TH ST S
Practice Address - Street 2:UNIT 1B
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8215
Practice Address - Country:US
Practice Address - Phone:239-435-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODNEV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM14949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty