Provider Demographics
NPI:1265659072
Name:WOODRUFF, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WOODRUFF
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:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:WATHENA
Mailing Address - State:KS
Mailing Address - Zip Code:66090-0111
Mailing Address - Country:US
Mailing Address - Phone:785-989-4941
Mailing Address - Fax:913-365-5606
Practice Address - Street 1:405 FREMONT
Practice Address - Street 2:
Practice Address - City:WATHENA
Practice Address - State:KS
Practice Address - Zip Code:66090
Practice Address - Country:US
Practice Address - Phone:785-989-4941
Practice Address - Fax:913-365-5606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3747P1801XMedicaid
KS3747A065OXMedicaid