Provider Demographics
NPI:1154045482
Name:WOODS, BRENDA M (RN CHT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:WOODS
Suffix:
Gender:F
Credentials:RN CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 TROSPER RD SW APT J203
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8129
Mailing Address - Country:US
Mailing Address - Phone:360-489-2386
Mailing Address - Fax:
Practice Address - Street 1:1922 TROSPER RD SW APT J203
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-8129
Practice Address - Country:US
Practice Address - Phone:360-489-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WARN60431293163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health