Provider Demographics
NPI:1063056182
Name:WOFFORD, DIANA BROOKE (RN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:BROOKE
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-7112
Mailing Address - Country:US
Mailing Address - Phone:434-713-4830
Mailing Address - Fax:
Practice Address - Street 1:1555 MEADOWVIEW DR STE 5
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-7352
Practice Address - Country:US
Practice Address - Phone:434-685-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001289179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse