Provider Demographics
NPI:1386882884
Name:WOODS, ANGELITA C
Entity type:Individual
Prefix:
First Name:ANGELITA
Middle Name:C
Last Name:WOODS
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 1:801 W BROADWAY
Mailing Address - Street 2:UNIT # 8
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2236
Mailing Address - Country:US
Mailing Address - Phone:502-851-1702
Mailing Address - Fax:502-384-7345
Practice Address - Street 1:801 W BROADWAY
Practice Address - Street 2:UNIT # 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2236
Practice Address - Country:US
Practice Address - Phone:502-851-1702
Practice Address - Fax:502-384-7345
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
KY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor