Provider Demographics
NPI:1841024361
Name:WOODWARD, RAELEY (IBCLC)
Entity type:Individual
Prefix:
First Name:RAELEY
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S AIR DEPOT BLVD STE 33
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4809
Mailing Address - Country:US
Mailing Address - Phone:405-615-0007
Mailing Address - Fax:
Practice Address - Street 1:1212 S AIR DEPOT BLVD STE 33
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4809
Practice Address - Country:US
Practice Address - Phone:405-615-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-311057174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN