MEDICARE: MIA WOODSON

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	374J00000X	Doula		OK

General Provider Information

NPI Number	:	1255273942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA WOODSON

Provider Business Mailing Address
First Line	:	20308 E 41ST PL S
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-1268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20308 E 41ST PL S
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-1268
Country	:	US
Telephone Number	:	314-495-4274
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ MIA WOODSON ” Practice Location

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