Healthcare Provider Details

I. General information

NPI: 1023954682
Provider Name (Legal Business Name): VICTORIA WOODARD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 30TH AVE S STE 103
FARGO ND
58104-8421
US

IV. Provider business mailing address

4133 30TH AVE S STE 103
FARGO ND
58104-8421
US

V. Phone/Fax

Practice location:
  • Phone: 701-499-4847
  • Fax: 701-433-1882
Mailing address:
  • Phone: 701-499-4847
  • Fax: 701-433-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL17328
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: