Provider Demographics
NPI:1912077322
Name:WOODSON, GUADALUPE ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:ELIZABETH
Last Name:WOODSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W UNIVERSITY AVE STE 206
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2996
Mailing Address - Country:US
Mailing Address - Phone:928-266-1530
Mailing Address - Fax:
Practice Address - Street 1:1016 W UNIVERSITY AVE STE 206
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2996
Practice Address - Country:US
Practice Address - Phone:928-266-1530
Practice Address - Fax:928-266-1531
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN32589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS85929Medicare UPIN