MEDICARE: ANDREA WOODGEARD 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	71006629A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71006629A	OTHER	IN	INDIANA BOARD OF NURSING APN PRESCRIPTIVE AUTHORITY
2	71006629B	OTHER	IN	INDIANA BOARD OF NURSING CONTROLLED SUBSTANCE REGISTRATION

General Provider Information

NPI Number	:	1588114599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WOODGEARD FNP-C

Provider Business Mailing Address
First Line	:	932 WINDSOR LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-2045
Country	:	US
Telephone Number	:	419-630-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 WINDSOR LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-2045
Country	:	US
Telephone Number	:	419-630-8106
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	05/05/2021

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