Provider Demographics
NPI:1558370106
Name:WOODARD, SUSAN TRENT SR (RN,NPC,MSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:TRENT
Last Name:WOODARD
Suffix:SR
Gender:F
Credentials:RN,NPC,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6658
Mailing Address - Country:US
Mailing Address - Phone:310-257-0508
Mailing Address - Fax:310-781-1424
Practice Address - Street 1:3445 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6658
Practice Address - Country:US
Practice Address - Phone:310-257-0508
Practice Address - Fax:310-781-1424
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280321164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP9239CMedicare ID - Type Unspecified
CAWPN9239BMedicare ID - Type Unspecified
CAWNP9239DMedicare ID - Type Unspecified
CAWNP9239EMedicare ID - Type Unspecified
CAP13563Medicare UPIN
CAWNP9239AMedicare ID - Type Unspecified