Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP115485 | TX |
NPI | 1154883767 |
---|---|
Provider Name | Mr. James William Woodwick JR. |
First Address | Lubbock, TX 79415-3364 |
Second Address | Lubbock, TX 79415-3364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |