Provider Demographics
NPI:1972197481
Name:WOODWARD, JOHNIECE ROBERTA (STNA)
Entity Type:Individual
Prefix:MS
First Name:JOHNIECE
Middle Name:ROBERTA
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6742 LABURNUM DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8595
Mailing Address - Country:US
Mailing Address - Phone:937-204-8355
Mailing Address - Fax:
Practice Address - Street 1:6742 LABURNUM DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8595
Practice Address - Country:US
Practice Address - Phone:937-204-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320343510599376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide