Provider Demographics
NPI:1780186189
Name:WOODALL, PATRICIA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:WOODALL
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 1:123 COUNTY ROAD 14430
Mailing Address - Street 2:
Mailing Address - City:PATTONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75468-2521
Mailing Address - Country:US
Mailing Address - Phone:903-517-8958
Mailing Address - Fax:
Practice Address - Street 1:703 OAK ST
Practice Address - Street 2:
Practice Address - City:HONEY GROVE
Practice Address - State:TX
Practice Address - Zip Code:75446-2139
Practice Address - Country:US
Practice Address - Phone:903-378-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669594163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health