Provider Demographics
NPI:1659651941
Name:WOODRUFF, DANNIELLE CHEYENNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DANNIELLE
Middle Name:CHEYENNE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12607 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:352-870-0968
Mailing Address - Fax:305-503-7223
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:352-870-0968
Practice Address - Fax:305-503-7223
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11433207R00000X
WAOP60339102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine