MEDICARE: MONIQUE CHANTELLE WOODFORK II

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	385H00000X	Respite Care
2	374U00000X	Home Health Aide
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467211169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE CHANTELLE WOODFORK II

Provider Business Mailing Address
First Line	:	3503 PENFIELD CT W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3732
Country	:	US
Telephone Number	:	614-957-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	3503 PENFIELD CT W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3732
Country	:	US
Telephone Number	:	614-957-6146
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	01/15/2026

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