Provider Demographics
NPI:1699243717
Name:WOODWARD, EMILIE H
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:H
Last Name:WOODWARD
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 1:3517 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7377
Mailing Address - Country:US
Mailing Address - Phone:907-455-9255
Mailing Address - Fax:907-452-1789
Practice Address - Street 1:3517 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7377
Practice Address - Country:US
Practice Address - Phone:907-455-9255
Practice Address - Fax:907-452-1789
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK165040Medicaid