Healthcare Provider Details

I. General information

NPI: 1164297750
Provider Name (Legal Business Name): CHANIQUA B WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 11/25/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 EVANGELINE ST
MONROE LA
71201-3749
US

IV. Provider business mailing address

807 EVANGELINE STREET
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-9995
  • Fax: 318-325-8943
Mailing address:
  • Phone: 318-654-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: