Provider Demographics
NPI:1396781720
Name:WOODARD, BEVERLY (CNM)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HERBERT AVE
Mailing Address - Street 2:FRUITION MIDWIFERY
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1229
Mailing Address - Country:US
Mailing Address - Phone:646-638-9388
Mailing Address - Fax:516-358-0278
Practice Address - Street 1:135 W 27TH ST FL 4
Practice Address - Street 2:FRUITION MIDWIFERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6226
Practice Address - Country:US
Practice Address - Phone:646-638-9388
Practice Address - Fax:212-463-9526
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000276176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife