Healthcare Provider Details

I. General information

NPI: 1245677087
Provider Name (Legal Business Name): ERIN ELIZABETH WOODIEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 ABNER JACKSON PKWY
LAKE JACKSON TX
77566-5124
US

IV. Provider business mailing address

270 ABNER JACKSON PKWY
LAKE JACKSON TX
77566-5124
US

V. Phone/Fax

Practice location:
  • Phone: 979-316-5100
  • Fax: 979-316-5098
Mailing address:
  • Phone: 979-316-5100
  • Fax: 979-316-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number678930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: