Provider Demographics
NPI:1780032912
Name:WOODHAM, MARCIA JOAN (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:JOAN
Last Name:WOODHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4340
Mailing Address - Country:US
Mailing Address - Phone:863-462-5819
Mailing Address - Fax:
Practice Address - Street 1:1728 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4340
Practice Address - Country:US
Practice Address - Phone:863-462-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9423913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse