Provider Demographics
NPI:1235712829
Name:WOODWARD, MARY REBECCA (RN BSN PHN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:REBECCA
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RN BSN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4860
Mailing Address - Country:US
Mailing Address - Phone:831-239-3945
Mailing Address - Fax:
Practice Address - Street 1:21507 E CLIFF DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4844
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95157956163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health