Provider Demographics
NPI:1427896083
Name:WOODHEAD, MICHAEL CHRISTIAN (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:WOODHEAD
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BRUIN DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5288
Mailing Address - Country:US
Mailing Address - Phone:385-209-9978
Mailing Address - Fax:
Practice Address - Street 1:206 E BRUIN DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5288
Practice Address - Country:US
Practice Address - Phone:385-209-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11130758-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily