Provider Demographics
NPI:1023365491
Name:WOODARD, SHANEE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:SHANEE
Middle Name:NICOLE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12685 DORSETT RD # 332
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2100
Mailing Address - Country:US
Mailing Address - Phone:314-583-3066
Mailing Address - Fax:636-281-0992
Practice Address - Street 1:1957 WILLIAMSTOWN DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-8106
Practice Address - Country:US
Practice Address - Phone:314-583-3066
Practice Address - Fax:636-281-0992
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care