Provider Demographics
NPI:1790199701
Name:WOODHOUSE, CALENE LYNETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:CALENE
Middle Name:LYNETTE
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 W 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2459
Mailing Address - Country:US
Mailing Address - Phone:563-421-3800
Mailing Address - Fax:563-421-3819
Practice Address - Street 1:1520 W 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2459
Practice Address - Country:US
Practice Address - Phone:563-421-3800
Practice Address - Fax:563-421-3819
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA073952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily