Healthcare Provider Details

I. General information

NPI: 1013235175
Provider Name (Legal Business Name): FLORENCE EMOGENE WOODS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 AXTELL DR
SUMMERVILLE SC
29485-3421
US

IV. Provider business mailing address

124 AXTELL DR
SUMMERVILLE SC
29485-3421
US

V. Phone/Fax

Practice location:
  • Phone: 843-814-8309
  • Fax:
Mailing address:
  • Phone: 843-814-8309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646757
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number518936
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: