Provider Demographics
NPI:1942821467
Name:WOODS, ANDREA (HLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:HLP
Other - Prefix:
Other - First Name:CAPTAIN
Other - Middle Name:
Other - Last Name:SMASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIRLOSSPRACTITIONER
Mailing Address - Street 1:3044 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-2100
Mailing Address - Country:US
Mailing Address - Phone:317-384-9181
Mailing Address - Fax:
Practice Address - Street 1:3919 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2531
Practice Address - Country:US
Practice Address - Phone:317-384-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0Medicaid