Healthcare Provider Details

I. General information

NPI: 1609824952
Provider Name (Legal Business Name): LINDA SUE WOODWARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WILLOW CREEK RD SUITE G
PRESCOTT AZ
86301-1645
US

IV. Provider business mailing address

29620 N 69TH ST SUITE G
SCOTTSDALE AZ
85266-8500
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-7343
  • Fax:
Mailing address:
  • Phone: 602-318-8876
  • Fax: 866-616-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN070288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: