Provider Demographics
NPI:1255432233
Name:WOODWARD, DONNA LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746720
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6720
Mailing Address - Country:US
Mailing Address - Phone:773-828-0232
Mailing Address - Fax:
Practice Address - Street 1:4401 W WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-2645
Practice Address - Country:US
Practice Address - Phone:574-725-7006
Practice Address - Fax:574-807-9614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily