Provider Demographics
NPI:1851174403
Name:WOODSIDE, CHRISTINA LOUISA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LOUISA
Last Name:WOODSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6901
Mailing Address - Country:US
Mailing Address - Phone:330-208-7393
Mailing Address - Fax:
Practice Address - Street 1:1867 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6901
Practice Address - Country:US
Practice Address - Phone:330-208-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.002179175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist