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General NPI Number Information
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NPI Number | 1457658361
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Entity Type | Individual
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Provider Name | TAMMY LYNN WOODWARD LPN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2011
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Last Update Date | 02/12/2011
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Provider Practice Location Address
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Address Line | 21308 JOHN MILLESS DR SUITE 202
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City | ROGERS
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State | MN
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Zip | 55374-4708
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Country | US
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Telephone | 763-428-3510
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Fax |
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Provider Business Mailing Address
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Address Line | 8331 285TH AVE NW
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4312
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Country | US
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Telephone | 763-389-9209
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L38940-4
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License Number State | MN
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