Provider Demographics
NPI:1255524203
Name:ELEANOR I WOODS
Entity type:Organization
Organization Name:ELEANOR I WOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:I
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:940-458-1915
Mailing Address - Street 1:1112 N STEMMONS ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-9305
Mailing Address - Country:US
Mailing Address - Phone:940-458-1915
Mailing Address - Fax:
Practice Address - Street 1:1112 N STEMMONS ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9305
Practice Address - Country:US
Practice Address - Phone:940-458-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162860401Medicaid
TX162860401Medicaid