Provider Demographics
NPI:1104633700
Name:WOODS, LASTASIA CIERRA
Entity type:Individual
Prefix:
First Name:LASTASIA
Middle Name:CIERRA
Last Name:WOODS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EUREKA RD STE F
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5842
Mailing Address - Country:US
Mailing Address - Phone:313-308-5038
Mailing Address - Fax:
Practice Address - Street 1:24719 LANGDON DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-1884
Practice Address - Country:US
Practice Address - Phone:313-308-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty