Provider Demographics
NPI:1568670024
Name:BONEY-WOODALL, YVETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:
Last Name:BONEY-WOODALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 KEDLESTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6375
Mailing Address - Country:US
Mailing Address - Phone:614-269-3238
Mailing Address - Fax:
Practice Address - Street 1:3903 KEDLESTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6375
Practice Address - Country:US
Practice Address - Phone:614-269-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-220417163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2316354Medicaid