Healthcare Provider Details

I. General information

NPI: 1154208049
Provider Name (Legal Business Name): MINDI A WOODRUFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S POWER RD STE 114
MESA AZ
85206-5236
US

IV. Provider business mailing address

215 S POWER RD STE 114
MESA AZ
85206-5236
US

V. Phone/Fax

Practice location:
  • Phone: 480-562-6644
  • Fax: 480-981-1405
Mailing address:
  • Phone: 480-562-6644
  • Fax: 480-981-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN184185
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: