Provider Demographics
NPI:1629662234
Name:WOOFTER, WENDY J
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:WOOFTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 3 LICK RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-4656
Mailing Address - Country:US
Mailing Address - Phone:681-495-2199
Mailing Address - Fax:
Practice Address - Street 1:953 3 LICK RD
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-4656
Practice Address - Country:US
Practice Address - Phone:681-495-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker