Provider Demographics
NPI:1134925738
Name:WOODALL, LILLIAN NICOLE (BSN, RN, CEN)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:NICOLE
Last Name:WOODALL
Suffix:
Gender:
Credentials:BSN, RN, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9253
Mailing Address - Country:US
Mailing Address - Phone:816-645-0888
Mailing Address - Fax:
Practice Address - Street 1:209 CUNNINGHAM INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-3915
Practice Address - Country:US
Practice Address - Phone:816-922-2161
Practice Address - Fax:816-922-4845
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025470163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care