Healthcare Provider Details

I. General information

NPI: 1609719012
Provider Name (Legal Business Name): SANDRA MARILU WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 PERKINS AVE
BROCKTON MA
02302-3851
US

IV. Provider business mailing address

172 PERKINS AVE
BROCKTON MA
02302-3851
US

V. Phone/Fax

Practice location:
  • Phone: 508-789-8482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2325494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: