Healthcare Provider Details

I. General information

NPI: 1922305044
Provider Name (Legal Business Name): NICOLE BRANDEN WOODDELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST STE 2000
LIMA OH
45801-4602
US

IV. Provider business mailing address

730 W MARKET ST STE 2000
LIMA OH
45801-4602
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5852
  • Fax:
Mailing address:
  • Phone: 419-996-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number350354
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0033946
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: