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NPI Code Detail

MEDICARE: NORA LYNN WOODWORTH

MEDICARE:   NORA LYNN WOODWORTH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1265254650
Entity Type Code : Individual
Provider Name (Legal Business Name) : NORA LYNN WOODWORTH
Provider Business Mailing Address
First Line : 913 ELLIOTT AVE
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-1117
Country : US
Telephone Number : 616-312-5530
Fax Number :
Provider Business Practice Location Address
First Line : 913 ELLIOTT AVE
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-1117
Country : US
Telephone Number : 616-312-5530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2024
Last Update Date : 10/30/2024

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Directions to “ NORA LYNN WOODWORTH ” Practice Location

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