Provider Demographics
NPI:1316275464
Name:WOODLEY, HANNAH ADELE LATTIMORE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ADELE LATTIMORE
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2628
Mailing Address - Country:US
Mailing Address - Phone:540-428-1715
Mailing Address - Fax:
Practice Address - Street 1:493 BLACKWELL RD STE 305
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2628
Practice Address - Country:US
Practice Address - Phone:540-428-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030641363A00000X
VA0110003113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant