Healthcare Provider Details

I. General information

NPI: 1245169044
Provider Name (Legal Business Name): TIANNE WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KENDALL DR
LAMAR CO
81052-3993
US

IV. Provider business mailing address

32775 COUNTY ROAD 33.5
MC CLAVE CO
81057-9745
US

V. Phone/Fax

Practice location:
  • Phone: 719-691-9644
  • Fax:
Mailing address:
  • Phone: 719-691-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.1642058
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: