Provider Demographics
NPI:1629335948
Name:WOODALL, RONALD JAY JR (RN NPP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAY
Last Name:WOODALL
Suffix:JR
Gender:M
Credentials:RN NPP
Other - Prefix:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38770 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6620
Practice Address - Country:US
Practice Address - Phone:586-421-4204
Practice Address - Fax:586-421-4222
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704201855363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care