Provider Demographics
NPI:1629488077
Name:WOODWARD, RENADA R (FNP-C)
Entity Type:Individual
Prefix:
First Name:RENADA
Middle Name:R
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CYPRESS POINT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4742
Mailing Address - Country:US
Mailing Address - Phone:609-351-2349
Mailing Address - Fax:
Practice Address - Street 1:508 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1052
Practice Address - Country:US
Practice Address - Phone:609-261-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00459600363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0455091OtherMEDICAID GROUP
NJ381020OtherMEDICARE GROUP