Provider Demographics
NPI:1669942553
Name:WOODLEY, CHRISTENE
Entity type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 CABRIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8052
Mailing Address - Country:US
Mailing Address - Phone:440-796-1319
Mailing Address - Fax:
Practice Address - Street 1:14814 FORD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9528
Practice Address - Country:US
Practice Address - Phone:440-628-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN279891163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice