Provider Demographics
NPI:1336618701
Name:WOODBURN, SONJA DENICE (RN)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:DENICE
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11292 COUNTY ROAD 3111 N
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-7584
Mailing Address - Country:US
Mailing Address - Phone:903-245-4800
Mailing Address - Fax:
Practice Address - Street 1:11292 COUNTY ROAD 3111 N
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-7584
Practice Address - Country:US
Practice Address - Phone:903-245-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse