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General NPI Number Information
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NPI Number | 1306306550
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Entity Type | Individual
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Provider Name | JUDY I WOODLEY
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Gender | Female
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 03/23/2019
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Provider Practice Location Address
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Address Line | 24284 BREAM ST
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City | COURTLAND
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State | VA
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Zip | 23837-2174
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Country | US
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Telephone | 757-556-6439
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Fax | 757-556-4715
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Provider Business Mailing Address
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Address Line | 24284 BREAM ST
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City | COURTLAND
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State | VA
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Zip | 23837-2174
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Country | US
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Telephone | 757-556-6439
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Fax | 757-556-4715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | VVW8288
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License Number State | VA
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