Provider Demographics
NPI:1932440195
Name:WOODSON, MARSHA LORRAINE (PA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LORRAINE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 E FLORIDA AVE
Mailing Address - Street 2:#103
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8643
Mailing Address - Country:US
Mailing Address - Phone:951-929-8121
Mailing Address - Fax:951-929-2421
Practice Address - Street 1:1600 E FLORIDA AVE
Practice Address - Street 2:#103
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8643
Practice Address - Country:US
Practice Address - Phone:951-929-8121
Practice Address - Fax:951-929-2421
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant