Provider Demographics
NPI:1326527508
Name:WOODHAM, SHIRENE (DNP FNP-BC AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:SHIRENE
Middle Name:
Last Name:WOODHAM
Suffix:
Gender:F
Credentials:DNP FNP-BC AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 S POWER RD STE 129
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3627
Mailing Address - Country:US
Mailing Address - Phone:480-751-3091
Mailing Address - Fax:480-751-3095
Practice Address - Street 1:4135 S POWER RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3627
Practice Address - Country:US
Practice Address - Phone:480-751-3091
Practice Address - Fax:480-751-3095
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226355363LG0600X, 363LA2100X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care