Provider Demographics
NPI:1346024189
Name:WOODS, THADDEA K (STNA)
Entity Type:Individual
Prefix:
First Name:THADDEA
Middle Name:K
Last Name:WOODS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9417 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-4725
Mailing Address - Country:US
Mailing Address - Phone:216-645-0234
Mailing Address - Fax:
Practice Address - Street 1:9417 MANOR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4725
Practice Address - Country:US
Practice Address - Phone:216-645-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602691780823376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide