Provider Demographics
NPI:1568120459
Name:WOODLEY, AUDREY
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:WOODLEY
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 1:1 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3302
Mailing Address - Country:US
Mailing Address - Phone:773-837-0967
Mailing Address - Fax:773-688-2834
Practice Address - Street 1:1 N STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3302
Practice Address - Country:US
Practice Address - Phone:773-837-0967
Practice Address - Fax:773-688-2834
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20-0270910OtherNON-MEDICAL