Provider Demographics
NPI:1568697373
Name:WOOLDRIDGE, JON D (RN)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BALSAM CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3206
Mailing Address - Country:US
Mailing Address - Phone:618-698-1569
Mailing Address - Fax:
Practice Address - Street 1:123 BALSAM CIRCLE LOT 142
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3206
Practice Address - Country:US
Practice Address - Phone:618-698-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse