MEDICARE: MRS. WENDY FLETCHER WOODBURY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	2153023102	UT

General Provider Information

NPI Number	:	1144290065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY FLETCHER WOODBURY RN

Provider Business Mailing Address
First Line	:	1363 N 200 W
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-1194
Country	:	US
Telephone Number	:	801-295-5832
Fax Number	:

Provider Business Practice Location Address
First Line	:	1363 N 200 W
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-1194
Country	:	US
Telephone Number	:	801-295-5832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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