Provider Demographics
NPI:1407537525
Name:WOODEN, CONSWELLA
Entity Type:Individual
Prefix:
First Name:CONSWELLA
Middle Name:
Last Name:WOODEN
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 1:470 CITI CTR ST # 1259
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3425
Mailing Address - Country:US
Mailing Address - Phone:863-216-6006
Mailing Address - Fax:
Practice Address - Street 1:2739 W EXETER ROAD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825
Practice Address - Country:US
Practice Address - Phone:863-257-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty