Provider Demographics
NPI:1972374320
Name:WOODRUFF, KATHLEEN MARIE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:1115 BERNOUDY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9415
Mailing Address - Country:US
Mailing Address - Phone:410-303-9844
Mailing Address - Fax:
Practice Address - Street 1:406 W PENNSYLVANIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4275
Practice Address - Country:US
Practice Address - Phone:410-816-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9511404363LA2200X
MN5838363LA2200X
WA60856968363LA2200X
MDRO76502363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health