Healthcare Provider Details

I. General information

NPI: 1104616341
Provider Name (Legal Business Name): MR. HENRY LEE WOODS III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N MANIFOLD LN
SPOKANE VALLEY WA
99016-5489
US

IV. Provider business mailing address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

V. Phone/Fax

Practice location:
  • Phone: 509-315-7191
  • Fax:
Mailing address:
  • Phone: 509-603-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number287199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: