Provider Demographics
NPI:1720501620
Name:WOODWARD, CAROL (NEVADA APRN002587)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:NEVADA APRN002587
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0835
Mailing Address - Country:US
Mailing Address - Phone:702-405-7100
Mailing Address - Fax:702-405-3017
Practice Address - Street 1:2480 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0835
Practice Address - Country:US
Practice Address - Phone:702-405-7100
Practice Address - Fax:702-405-3017
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002587363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002587OtherADVANCED PRACTICE CERTIFICATE (APRN)
NVMW4443191OtherDEA CERTIFICATE EXPIRES 5/31/2020