Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2018044829 | MO |
NPI | 1013480979 |
---|---|
Provider Name | Angela L Woods |
First Address | Marshall, MO 65340-3702 |
Second Address | Marshall, MO 65340-3702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 06/05/2021 |