Provider Demographics
NPI:1104947993
Name:WOODSON, LINDA A
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:WOODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 NC HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-9724
Mailing Address - Country:US
Mailing Address - Phone:336-349-2585
Mailing Address - Fax:336-349-3174
Practice Address - Street 1:121 SQUIRREL TRAIL
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-349-2585
Practice Address - Fax:336-349-3174
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL079016376G00000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator