Provider Demographics
NPI:1912511635
Name:WOODY, DESIREE ANNE
Entity Type:Individual
Prefix:MISS
First Name:DESIREE
Middle Name:ANNE
Last Name:WOODY
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:PO BOX 2811
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-2811
Mailing Address - Country:US
Mailing Address - Phone:970-342-4099
Mailing Address - Fax:
Practice Address - Street 1:4745 COFFEETREE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5632
Practice Address - Country:US
Practice Address - Phone:970-342-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider