Provider Demographics
NPI:1821023409
Name:WOODARD, LUCILLE ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:ROSE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10135 S 25TH ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-292-2877
Mailing Address - Fax:402-292-4034
Practice Address - Street 1:10135 S 25TH ST STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3505
Practice Address - Country:US
Practice Address - Phone:402-292-2877
Practice Address - Fax:402-292-4034
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine