Provider Demographics
NPI:1720636210
Name:WOODSIDE, ALBERTA M
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:M
Last Name:WOODSIDE
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:VA ST LOUIS SPINAL CORD INJURY UNIT
Mailing Address - Street 2:1 JEFFERSON BARRACKS DRIVE 128/JB
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1083 VIOLET RD
Practice Address - Street 2:
Practice Address - City:COULTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62237
Practice Address - Country:US
Practice Address - Phone:618-316-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider