Healthcare Provider Details

I. General information

NPI: 1417820408
Provider Name (Legal Business Name): SONNA N. WOODHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 OLD WASHINGTON RD STE 201
WALDORF MD
20602-3235
US

IV. Provider business mailing address

3510 OLD WASHINGTON RD STE 201
WALDORF MD
20602-3235
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8035
  • Fax: 301-645-5229
Mailing address:
  • Phone: 301-645-8035
  • Fax: 301-645-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR121398
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: