Provider Demographics
NPI:1467765628
Name:WOODHOUSE, MORINE (FNP)
Entity Type:Individual
Prefix:
First Name:MORINE
Middle Name:
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 PIERCE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8437
Mailing Address - Country:US
Mailing Address - Phone:917-691-6188
Mailing Address - Fax:718-386-4478
Practice Address - Street 1:2976 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1733
Practice Address - Country:US
Practice Address - Phone:470-579-6599
Practice Address - Fax:912-243-9650
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1467765628Medicaid