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General NPI Number Information
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NPI Number | 1902130107
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Entity Type | Organization
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Legal Business Name | MAURA WOODWARD, LLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 2560 DIXWELL AVE SUITE 3C
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City | HAMDEN
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State | CT
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Zip | 06514-1851
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Country | US
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Telephone | 203-287-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 DIXWELL AVE SUITE 3C
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City | HAMDEN
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State | CT
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Zip | 06514-1851
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Country | US
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Telephone | 203-287-0601
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAURA J WOODWARD
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Credential | APRN
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Telephone | 203-287-0601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 001935
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License Number State | CT
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