Provider Demographics
NPI:1821031501
Name:WOODS, NANCY JEAN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:WOODS
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CATAMARAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1345
Mailing Address - Country:US
Mailing Address - Phone:636-625-2702
Mailing Address - Fax:
Practice Address - Street 1:ST JOHN'S URGENT CARE CENTER
Practice Address - Street 2:300 WINDING WOODS DRIVE SUITE 100
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366
Practice Address - Country:US
Practice Address - Phone:636-379-4329
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPO5883Medicare ID - Type Unspecified