Provider Demographics
NPI:1578817391
Name:WOODSTOCK, YVONNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:WOODSTOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15675 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2523
Mailing Address - Country:US
Mailing Address - Phone:206-433-2413
Mailing Address - Fax:
Practice Address - Street 1:15675 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2523
Practice Address - Country:US
Practice Address - Phone:206-433-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00054363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse