Provider Demographics
NPI:1851432918
Name:WOODYARD, DARLENE SUZANNE (RN, LMP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:SUZANNE
Last Name:WOODYARD
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4225
Mailing Address - Country:US
Mailing Address - Phone:253-833-1833
Mailing Address - Fax:253-833-4246
Practice Address - Street 1:821 HARVEY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4225
Practice Address - Country:US
Practice Address - Phone:253-833-1833
Practice Address - Fax:253-833-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA40326OtherLABOR & INDUSTRY