Healthcare Provider Details

I. General information

NPI: 1720335441
Provider Name (Legal Business Name): VERONICA DAWN WOODFORD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 UPPER CHESAPEAKE DR STE 301
BEL AIR MD
21014-4375
US

IV. Provider business mailing address

520 UPPER CHESAPEAKE DR STE 301
BEL AIR MD
21014-4375
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-3121
  • Fax: 443-643-4303
Mailing address:
  • Phone: 410-939-3121
  • Fax: 443-643-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR265778
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number53-75687-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: