Provider Demographics
NPI:1760443303
Name:WOODWARD, CHRISTINE M (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:M
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 LEAD HILL BLVD.
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-677-1200
Mailing Address - Fax:916-677-1204
Practice Address - Street 1:1650 LEAD HILL BLVD.
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-677-1200
Practice Address - Fax:916-677-1204
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT950684AMedicare ID - Type Unspecified