Healthcare Provider Details

I. General information

NPI: 1700625928
Provider Name (Legal Business Name): STACEY ANN WOODRUFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2008
CINCINNATI OH
45229-2833
US

IV. Provider business mailing address

804 FAIRLANE RD
BUTLER KY
41006-8679
US

V. Phone/Fax

Practice location:
  • Phone: 859-512-8153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036157
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: