Healthcare Provider Details

I. General information

NPI: 1861354201
Provider Name (Legal Business Name): LANCE ALLAN WOODYARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 UNIVERSITY AVE
WATERLOO IA
50701-5656
US

IV. Provider business mailing address

4000 UNIVERSITY AVE
WATERLOO IA
50701-5656
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-1230
  • Fax: 319-226-8417
Mailing address:
  • Phone: 319-235-1230
  • Fax: 319-226-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP53464
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: