Provider Demographics
NPI: | 1710961354 |
---|---|
Name: | WOODS, ELIZABETH J (NP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | ELIZABETH |
Middle Name: | J |
Last Name: | WOODS |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | MS |
Other - First Name: | ELIZABETH |
Other - Middle Name: | J |
Other - Last Name: | WINNINGER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 354 BIRNIE AVENUE SUITE 202 |
Mailing Address - Street 2: | HAMPDEN COUNTY PHYSICIAN ASSOCIATES |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01107 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-733-3470 |
Mailing Address - Fax: | 413-733-5235 |
Practice Address - Street 1: | 354 BIRNIE AVE |
Practice Address - Street 2: | SUITE 202 |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01107-1108 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-733-3470 |
Practice Address - Fax: | 413-733-5235 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-12-06 |
Last Update Date: | 2012-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 208126 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | NP2834 | Medicare PIN | |
P17464 | Medicare UPIN | ||
500019126 | Medicare PIN |