Healthcare Provider Details

I. General information

NPI: 1568120459
Provider Name (Legal Business Name): MS. AUDREY WOODLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N STATE ST
CHICAGO IL
60602-3302
US

IV. Provider business mailing address

1 N STATE ST
CHICAGO IL
60602-3302
US

V. Phone/Fax

Practice location:
  • Phone: 773-837-0967
  • Fax: 773-688-2834
Mailing address:
  • Phone: 773-837-0967
  • Fax: 773-688-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: