1013403708 NPI number — MRS. ANDRA DAWN WOODARD LBSW

Table of content: MRS. ANDRA DAWN WOODARD LBSW (NPI 1013403708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013403708 NPI number — MRS. ANDRA DAWN WOODARD LBSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODARD
Provider First Name:
ANDRA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LBSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLINE
Provider Other First Name:
ANDRA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013403708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWARD
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99664-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-224-5850
Provider Business Mailing Address Fax Number:
360-868-1461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10599 FOX CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWARD
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-491-1581
Provider Business Practice Location Address Fax Number:
360-868-1461
Provider Enumeration Date:
07/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  105894 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105894 . This is a "ALASKA STATE LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com