Provider Demographics
NPI:1528271681
Name:WOODWARD, HOLLIS (RN, FNP)
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 WEST REDDING RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-778-1962
Mailing Address - Fax:
Practice Address - Street 1:67D MAIN ST
Practice Address - Street 2:MINUTE CLINIC DIAGNOSTICS OF MA LLC
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1831
Practice Address - Country:US
Practice Address - Phone:203-778-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330116363LF0000X
CT000083363LF0000X
MARN2283951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily