Healthcare Provider Details

I. General information

NPI: 1659489219
Provider Name (Legal Business Name): SUE ALLYSON WOODSON C.N.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-8902
US

IV. Provider business mailing address

2964 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-8902
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-1000
  • Fax: 434-975-3424
Mailing address:
  • Phone: 434-296-1000
  • Fax: 434-975-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001082072
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024082072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: