Provider Demographics
NPI:1184106924
Name:TAMARA T WOODSON
Entity type:Organization
Organization Name:TAMARA T WOODSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:314-305-5406
Mailing Address - Street 1:6725 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1417
Mailing Address - Country:US
Mailing Address - Phone:314-305-5406
Mailing Address - Fax:
Practice Address - Street 1:6725 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1417
Practice Address - Country:US
Practice Address - Phone:314-305-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care