Healthcare Provider Details

I. General information

NPI: 1497582589
Provider Name (Legal Business Name): SARAH NICOLE WOODY LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12917 CERISE AVE
HAWTHORNE CA
90250-5520
US

IV. Provider business mailing address

13524 AVALON BLVD APT 7
LOS ANGELES CA
90061-2600
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-4431
  • Fax:
Mailing address:
  • Phone: 310-889-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number744778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: