Provider Demographics
NPI:1386975076
Name:WOODARD, DEBRA ANN (CRNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6744
Mailing Address - Country:US
Mailing Address - Phone:410-549-1601
Mailing Address - Fax:
Practice Address - Street 1:6449 KNIGHT DR
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6744
Practice Address - Country:US
Practice Address - Phone:410-549-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089069363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN69855OtherSTATE OF MARYLAND