Provider Demographics
NPI:1649563651
Name:WOODARD, GREGORY K (FNP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:WOODARD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3830
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-3830
Mailing Address - Country:US
Mailing Address - Phone:671-645-5500
Mailing Address - Fax:671-645-5549
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GUAM
Practice Address - Zip Code:96929
Practice Address - Country:UM
Practice Address - Phone:671-645-5500
Practice Address - Fax:671-645-5549
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015809363LA2100X, 363LA2200X, 363LF0000X, 363LP2300X
GURE1895 / NP0129363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily