MEDICARE: MICHELLE WOODELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-07634	NC

General Provider Information

NPI Number	:	1154836245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE WOODELL PA-C

Provider Business Mailing Address
First Line	:	4601 LAKE BOONE TRL STE 3A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 LAKE BOONE TRL STE 3A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7518
Country	:	US
Telephone Number	:	919-709-7307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	11/29/2023

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