Healthcare Provider Details

I. General information

NPI: 1669942553
Provider Name (Legal Business Name): CHRISTENE WOODLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14814 FORD RD
MADISON OH
44057-9528
US

IV. Provider business mailing address

9020 CABRIOLET AVE
MENTOR OH
44060-8052
US

V. Phone/Fax

Practice location:
  • Phone: 440-628-4523
  • Fax:
Mailing address:
  • Phone: 440-796-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN279891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: