Provider Demographics
NPI:1750343190
Name:WOODCOCK, LISA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:6799 GREAT OAKS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2584
Mailing Address - Country:US
Mailing Address - Phone:901-685-3490
Mailing Address - Fax:901-685-3499
Practice Address - Street 1:6029 WALNUT GROVE RD STE C002
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-685-3490
Practice Address - Fax:901-685-3499
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN8068363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P94969Medicare UPIN
3349510Medicare ID - Type Unspecified