Provider Demographics
NPI:1396346557
Name:WOODS, PRINCE TERRENCE C
Entity type:Individual
Prefix:
First Name:PRINCE TERRENCE
Middle Name:C
Last Name:WOODS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 N 25TH AVE APT K209
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6514
Mailing Address - Country:US
Mailing Address - Phone:708-548-8754
Mailing Address - Fax:
Practice Address - Street 1:15620 N 25TH AVE APT K209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6514
Practice Address - Country:US
Practice Address - Phone:708-548-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide