Provider Demographics
NPI:1801104542
Name:WOODLAND, GWENDOLYN IRENE (NP)
Entity type:Individual
Prefix:MISS
First Name:GWENDOLYN
Middle Name:IRENE
Last Name:WOODLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 S HARRELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3599
Mailing Address - Country:US
Mailing Address - Phone:225-753-4482
Mailing Address - Fax:225-389-0802
Practice Address - Street 1:16441 S HARRELLS FERRY RD
Practice Address - Street 2:APT. 3706
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3599
Practice Address - Country:US
Practice Address - Phone:225-753-4482
Practice Address - Fax:225-389-0802
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR689882363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care