Provider Demographics
NPI:1457038200
Name:WOODHOUSE, HEATHER MAE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:WOODHOUSE
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 1:840 CORDWELL CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5810
Mailing Address - Country:US
Mailing Address - Phone:916-705-9292
Mailing Address - Fax:
Practice Address - Street 1:840 CORDWELL CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5810
Practice Address - Country:US
Practice Address - Phone:916-705-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756798163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health