1558594770 NPI number — MS. DANNAJESELLE KEIVETTE WOODSON N.D., MSOM

Table of content: MS. DANNAJESELLE KEIVETTE WOODSON N.D., MSOM (NPI 1558594770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558594770 NPI number — MS. DANNAJESELLE KEIVETTE WOODSON N.D., MSOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODSON
Provider First Name:
DANNAJESELLE
Provider Middle Name:
KEIVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.D., MSOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODSON
Provider Other First Name:
JESSY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ND, MSOM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558594770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1727 GEORGES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19131-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-292-1282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2288 SECOND STREET PIKE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18940-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-598-0223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2009

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: 101Y00000X , with the licence number:  NAT100862 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com