Provider Demographics
NPI:1982346987
Name:WOODRUM, ANDREA SUE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:WOODRUM
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 1:5246 STRAIGHT FRK
Mailing Address - Street 2:
Mailing Address - City:GRIFFITHSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25521-9505
Mailing Address - Country:US
Mailing Address - Phone:304-915-6296
Mailing Address - Fax:
Practice Address - Street 1:5246 STRAIGHT FRK
Practice Address - Street 2:
Practice Address - City:GRIFFITHSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25521-9505
Practice Address - Country:US
Practice Address - Phone:304-915-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant