MEDICARE: VICTORIA WOODARD FNP-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	363LF0000X	Family Nurse Practitioner	209032091	IL

General Provider Information

NPI Number	:	1215731674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA WOODARD FNP-C

Provider Business Mailing Address
First Line	:	20015 S LAGRANGE RD # 1048
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	231-288-8829
Fax Number	:

Provider Business Practice Location Address
First Line	:	20015 S LAGRANGE RD # 1141
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	231-288-8829
Fax Number	:

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

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/04/2025

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