Healthcare Provider Details

I. General information

NPI: 1619997897
Provider Name (Legal Business Name): LISA S WOODWARD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 J ST
SACRAMENTO CA
95816-4300
US

IV. Provider business mailing address

2825 J ST
SACRAMENTO CA
95816-4300
US

V. Phone/Fax

Practice location:
  • Phone: 916-978-0300
  • Fax: 916-978-0333
Mailing address:
  • Phone: 916-978-0300
  • Fax: 916-978-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number413942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: