Provider Demographics
NPI:1255536967
Name:WOODS, KATHY JOANNE (LPN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JOANNE
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1721
Mailing Address - Country:US
Mailing Address - Phone:218-214-0130
Mailing Address - Fax:
Practice Address - Street 1:12412 IOWA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1721
Practice Address - Country:US
Practice Address - Phone:218-214-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.122810164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse