Healthcare Provider Details

I. General information

NPI: 1285352393
Provider Name (Legal Business Name): NICOLE ANNE WOODARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LILLY RD NE STE 100
OLYMPIA WA
98506-5195
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8525
  • Fax: 360-412-6477
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61498186
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: