Provider Demographics
NPI:1831790823
Name:ANDERSON WOODS, SIMAIRA
Entity type:Individual
Prefix:
First Name:SIMAIRA
Middle Name:
Last Name:ANDERSON WOODS
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 1:4235 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1852
Mailing Address - Country:US
Mailing Address - Phone:402-972-1671
Mailing Address - Fax:
Practice Address - Street 1:4235 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1852
Practice Address - Country:US
Practice Address - Phone:402-972-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide