Provider Demographics
NPI:1326527185
Name:WOODY, YVONNE LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:LEE
Last Name:WOODY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COTTON CT
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5114
Mailing Address - Country:US
Mailing Address - Phone:979-267-0003
Mailing Address - Fax:
Practice Address - Street 1:101 VERDE DR APT 11204
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-3139
Practice Address - Country:US
Practice Address - Phone:979-665-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX878609163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX708384824Medicaid