Provider Demographics
NPI:1457658361
Name:WOODWARD, TAMMY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8331 285TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4312
Mailing Address - Country:US
Mailing Address - Phone:763-389-9209
Mailing Address - Fax:
Practice Address - Street 1:21308 JOHN MILLESS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4708
Practice Address - Country:US
Practice Address - Phone:763-428-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL38940-4164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNL38940-4OtherLPN LICENSE