Healthcare Provider Details

I. General information

NPI: 1881749380
Provider Name (Legal Business Name): NAFISEH F. WOODARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 SISSONVILLE DR
CHARLESTON WV
25312-9444
US

IV. Provider business mailing address

PO BOX 70
DAWES WV
25054-0070
US

V. Phone/Fax

Practice location:
  • Phone: 304-984-1576
  • Fax: 304-984-1565
Mailing address:
  • Phone: 304-734-2040
  • Fax: 304-734-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1851
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: