Provider Demographics
NPI:1215456025
Name:WOODY, GWENDOLYN SHERRON (LPN)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:SHERRON
Last Name:WOODY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 KIRBY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2853
Mailing Address - Country:US
Mailing Address - Phone:281-249-9444
Mailing Address - Fax:
Practice Address - Street 1:20 TREEWAY CT APT 2C
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-4453
Practice Address - Country:US
Practice Address - Phone:443-885-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP47734164W00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No164W00000XNursing Service ProvidersLicensed Practical Nurse