Provider Demographics
NPI:1962006452
Name:WOODFORK, DORSHEA (LPN)
Entity Type:Individual
Prefix:
First Name:DORSHEA
Middle Name:
Last Name:WOODFORK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5610
Mailing Address - Country:US
Mailing Address - Phone:563-219-2864
Mailing Address - Fax:
Practice Address - Street 1:518 8TH AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5610
Practice Address - Country:US
Practice Address - Phone:563-219-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP63977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA85-4029920OtherHOMECARE