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General NPI Number Information
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NPI Number | 1568697373
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Entity Type | Individual
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Provider Name | JON D WOOLDRIDGE RN
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Gender | Male
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 123 BALSAM CIRCLE LOT 142
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City | JACKSON
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State | MO
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Zip | 63755-3206
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Country | US
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Telephone | 618-698-1569
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Fax |
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Provider Business Mailing Address
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Address Line | 123 BALSAM CIR
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City | JACKSON
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State | MO
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Zip | 63755-3206
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Country | US
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Telephone | 618-698-1569
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 120027
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License Number State | MO
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