Provider Demographics
NPI:1104266568
Name:WOODWARD, LISA C (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:WOODWARD
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 1:778 STATE HIGHWAY 349
Mailing Address - Street 2:GRIFFIS RD
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-6846
Mailing Address - Country:US
Mailing Address - Phone:518-844-8183
Mailing Address - Fax:
Practice Address - Street 1:2372 STATE HIGHWAY 30A
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3906
Practice Address - Country:US
Practice Address - Phone:518-762-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605396-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse