Provider Demographics
NPI:1750673315
Name:WOODARD, BENJAMIN WILLIAM (MSN, NP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:WOODARD
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Gender:M
Credentials:MSN, NP
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Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:GREENFIELD HEALTH CENTER
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1521
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:413-772-3314
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:413-772-3314
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2015-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2300552363LF0000X
CA791490163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400247784Medicare PIN