Provider Demographics
NPI:1649219973
Name:WOODARD, PATRICIA ANN (RD)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:ANN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BOGART CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3508
Mailing Address - Country:US
Mailing Address - Phone:336-713-3022
Mailing Address - Fax:336-713-3038
Practice Address - Street 1:NORTH CAROLINA BAPTIST HOSPITAL
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-3022
Practice Address - Fax:336-713-3038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL000301OtherNC DIETITIAN/NUTRITIONIST
NC2993687Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NCQ15895Medicare UPIN